Unraveling an Enigmatic Triad: A Case Report of Concurrent Neurosyphilis, Ocular Syphilis, and Otosyphilis in a Patient with HIV
Abstract
Introduction: Patients with human immunodeficiency virus (HIV) often present with overlapping stages and less obvious signs of syphilis, with potential serious complications including neurosyphilis. Neurosyphilis is a neurological manifestation resulting from the progression of syphilis, a sexually transmitted infection caused by the bacterium Treponema pallidum.
Case Report: We report the case of a 39-year-old previously incarcerated male with a history of HIV on antiretroviral therapy and previous methamphetamine use who was referred to the emergency department from an Ophthalmologist with a diagnosis of anterior uveitis and papilledema, with reported associated symptoms of blurry vision, tinnitus, and forgetfulness. Comprehensive diagnostic testing, including lumbar puncture and cerebrospinal fluid analysis corroborated the diagnosis of neurosyphilis with otic and ocular involvement. The patient received intravenous aqueous crystalline penicillin G resulting in symptom improvement.
Conclusion: Given the prevalence of syphilis and its diverse manifestations, clinicians must maintain a high index of suspicion in patients who are immunocompromised or engage in high-risk behaviors to facilitate early diagnosis and treatment, which are crucial for optimal outcomes and enhanced prognosis.