SHM Converge Scientific Abstract ePoster Gallery-You Don't Need Bifocals, You Need Penicillin

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This case describes a 51-year-old man with delayed diagnosis of ocular syphilis after multiple healthcare visits. Five months before hospital diagnosis, he first saw a primary care physician for a diffuse erythematous macular rash that improved after a short steroid trial. Three months later, he developed bilateral blurry vision and a scotoma in the right eye, but his symptoms were initially attributed to a possible central artery occlusion/TIA related to atrial fibrillation, and he was started on apixaban. Only one week before hospitalization, worsening vision prompted repeat ophthalmology evaluation, syphilis serology, and emergency referral.<br /><br />At hospital presentation, he reported progressive blurry vision and floaters. He denied a genital chancre and reported only one sexual partner. Exam showed bilateral visual field defects; infectious testing for HIV, gonorrhea/chlamydia, and Lyme disease was negative. Ophthalmology found bilateral cystoid macular edema consistent with syphilitic uveitis. He was treated with IV penicillin G for 10 days and topical prednisolone acetate, with mild improvement on follow-up.<br /><br />The case highlights several practice lessons: syphilis can present without classic primary lesions, ocular involvement can occur at any stage, and delayed treatment risks irreversible vision loss. Rising syphilis rates, including in Michigan, make a high index of suspicion essential for both outpatient and inpatient clinicians. Early recognition of unexplained rash, neurologic, or visual symptoms could prevent progression and serious complications.

Asset Subtitle

Shehroz Malik

Meta Tag

Author List Peter Watson, Shehroz Malik

Category Clinical Vignettes

Concept Syphilis

Concept Ocular Syphilis

Concept Syphilis Testing

Concept Syphilis Treatment

Concept Intravenous Penicillin G

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Shehroz Malik

Track Adult

Keywords

ocular syphilis

syphilitic uveitis

bilateral blurry vision

cystoid macular edema

delayed diagnosis

penicillin G

visual field defects

macular rash

HIV negative

vision loss

Syphilis

Ocular Syphilis

Syphilis Testing

Syphilis Treatment

Intravenous Penicillin G