Old but Ageless Disease: Neurosyphilis withOcular Manifestations in an HIV-NegativePatient

Abstract

Syphilitic uveitis is mostly observed in patients with comorbid risk factors such as humanimmunodeficiency virus (HIV). Here, we present a case of syphilitic uveitis that began withpainless oral ulcers in an HIV negative male, whose primary and secondary phases were notdetected.Case: A 47-year old male with no significant medical history arrived at the Ear-Nose-ThroatDepartment in September 2018 with a sore throat, fatigue, fever, and painless ulcers inhis mouth. After a while, he applied to the Ophthalmology Department with complaintsof stinging and decreased vision in the left eye. Hyperotofluorescent foci of his right eyewere active in the upper and temporal parts of the macula. He was then diagnosed withsyphilitic uveitis in our unit and was found HIV-negative. His test results showed positiveof Venereal Diseases Research Laboratory (VDRL): 1/64 and T. pallidum haemagglutinationassay: 1/10240. Lumber punction was performed with no cells/microorganisms. Hiscerebrospinal fluid investigation revealed positive VDRL of 1:32 titre. He was successfullytreated with crystallized penicillin G and topical corticosteroids on his eyes. On the$14^{th}$ 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 thoseHIV-negative – in the differential diagnosis of painless ulcers and ocular manifestationseven if the lesion sites are atypical in order to prevent delay in diagnosis and treatment.