Old but ageless disease: neurosyphilis with ocular manifestations in an HIV-negative patient

Abstract

Syphilitic uveitis is mostly observed in patients with comorbid risk factors such as human immunodeficiency virus (HIV). Here, we present a case of syphilitic uveitis that began with painless oral ulcers in an HIV negative male, whose primary and secondary phases were not detected. Case: A 47-year old male with no significant medical history arrived at the Ear-Nose-Throat Department in September 2018 with a sore throat, fatigue, fever, and painless ulcers in his mouth. After a while, he applied to the Ophthalmology Department with complaints of stinging and decreased vision in the left eye. Hyperotofluorescent foci of his right eye were active in the upper and temporal parts of the macula. He was then diagnosed with syphilitic uveitis in our unit and was found HIV-negative. His test results showed positive of Venereal Diseases Research Laboratory (VDRL): 1/64 and T. pallidum haemagglutination assay: 1/10240. Lumber punction was performed with no cells/microorganisms. His cerebrospinal fluid investigation revealed positive VDRL of 1:32 titre. He was successfully treated with crystallized penicillin G and topical corticosteroids on his eyes. On the 14th day of the treatment, the patient was discharged with no complaints with his eyes. Syphilis should always be kept in mind –especially in low-risk groups such as those HIV-negative – in the differential diagnosis of painless ulcers and ocular manifestations even if the lesion sites are atypical in order to prevent delay in diagnosis and treatment.