SHM Converge Scientific Abstract ePoster Gallery-More Than Meets the Eye: A Case of Ocular Syphilis and Hiv Coinfection

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This case describes a 26-year-old homeless, uninsured man who presented with two weeks of progressive left eye vision loss, eventually becoming complete vision loss, along with a diffuse desquamating rash involving the trunk, palms, and soles. He reported a penile lesion and rash three months earlier and had a history of unprotected sex with men and women.<br /><br />Examination showed left conjunctival injection, decreased visual acuity, and panuveitis/posterior uveitis on slit lamp exam. Laboratory testing revealed HIV-1 infection with severe immunosuppression (CD4 count 46 cells/µL), positive gonorrhea and chlamydia PCR, CMV viremia, and a rapid plasma reagin titer of 1:32. Lumbar puncture was negative for VDRL, and additional infectious testing was negative for several alternative causes of retinitis/uveitis. Because of concern for viral retinitis in a patient with advanced HIV, empiric IV and intravitreal ganciclovir were started. He was later treated with IV penicillin G for ocular syphilis and started on antiretroviral therapy.<br /><br />The case highlights that ocular syphilis can occur at any stage of syphilis and should be considered in patients with vision changes, especially when accompanied by rash. HIV and syphilis coinfection is much more common than syphilis alone and increases the risk of ocular syphilis. Patients with ocular syphilis should be screened for HIV.<br /><br />The discussion also emphasizes major barriers to HIV care, including youth, low CD4 count, unstable housing, lack of insurance, transportation issues, and limited social support. Despite multidisciplinary discharge planning and linkage to services for medication, insurance, and housing support, the patient was lost to follow-up. Early recognition and treatment are essential to prevent permanent vision loss and other neurologic complications.

Asset Subtitle

Tracy Dinh

Meta Tag

Author List Ethan Molitch-HoU, Meggan M. Forbes, Tracy Dinh

Category Clinical Vignettes

Concept Ocular Syphilis

Concept Vision Loss

Concept Permanent Vision Loss

Concept HIV Coinfection

Concept Ocular Examination

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Tracy Dinh

Track Adult

Keywords

ocular syphilis

vision loss

HIV infection

panuveitis

posterior uveitis

syphilis rash

CMV viremia

unprotected sex

homelessness

ganciclovir

Ocular Syphilis

Vision Loss

Permanent Vision Loss

HIV Coinfection

Ocular Examination