Objective:

NA

Background:

Cases of syphilis have been steadily increasing in the US since 2017 with an alarming increase of 32% from 2020 to 2021. Ocular manifestations are seen in secondary and tertiary syphilis in the form of keratitis, scleritis, uveitis, and rarely, optic neuritis. Few studies report that HIV-coinfection contributes to earlier presentations of ocular syphilis and optic-nerve involvement. 

Design/Methods:

NA

Results:

A 20-year-old man presented with a 6-week history of right vision changes. It started as a single black spot, later evolving to several spots with patchy areas of blurred vision. He was diagnosed with Cryptococcus enterocolitis 3 months ago but was not checked for HIV. He also endorsed intermittent right-sided headaches, worsening dyspnea, and unintentional weight loss. Optic-disc edema and splinter hemorrhages were noted on the right eye on fundoscopy. MRI of the brain and orbits was unrevealing. Lumbar-puncture revealed elevated WBC of 30/cmm with 89% lymphocytes, high-normal protein(53mg/dL), normal glucose(58mg/dL), and negative VDRL. Further history revealed recent unprotected sex with multiple partners. HIV antibody testing was positive (viral load 246,000) with CD4 count of 154. RPR-with-reflex was also positive (1:64 titer). He was subsequently started on a 14-day course of intravenous penicillin.

Conclusions:

Here, we present a rare case of ocular syphilis with an HIV co-infection. Literature reports an increase in ocular manifestations with concurrent HIV and syphilis infections. RPR and VDRL titers are often higher in patients with HIV co-infection. HIV patients with syphilis are also noted to have higher viral loads and lower CD4 counts, both of which improve after treatment of syphilis. Improvement in vision is generally seen in most patients with treatment. This case highlights the importance of being cognizant of the association between undiagnosed/newly-diagnosed HIV and ocular syphilis when at-risk patient population presents with visual symptoms, especially given the associated therapeutic benefits between these two diseases.