# Unraveling an Enigmatic Triad: A Case Report of Concurrent Neurosyphilis, Ocular Syphilis, and Otosyphilis in a Patient with HIV

## TL;DR

This case report describes a patient with HIV who had three rare forms of syphilis and highlights the importance of early detection and treatment.

## Contribution

The report presents a rare case of concurrent neurosyphilis, ocular syphilis, and otosyphilis in an HIV patient, emphasizing the need for early detection.

## Key findings

- A 39-year-old HIV patient showed symptoms of neurosyphilis, ocular syphilis, and otosyphilis.
- Treatment with intravenous penicillin G led to symptom improvement.
- Early detection and treatment are crucial for preventing complications in HIV patients with syphilis.

## Abstract

Patients with HIV disease, regardless of the phase of infection, can present with overlapping stages and less distinct signs of syphilis, complicating diagnosis and treatment. Treponema pallidum, the bacterium responsible for syphilis, can lead to neurosyphilis, ocular syphilis, and otosyphilis when left untreated. Therefore, early detection of syphilis coinfection in HIV patients and timely treatment have demonstrated prompt improvement of symptoms, mitigating the risk of serious complications.

We report the case of a 39-year-old previously incarcerated male with a significant history of HIV on antiretroviral therapy and previous methamphetamine abuse referred to the emergency department from an ophthalmologist with a diagnosis of anterior uveitis and papilledema. The patient reported experiencing blurry vision, tinnitus, and memory difficulties. A thorough history and physical examination, along with diagnostic procedures, including lumbar puncture and cerebrospinal fluid analysis, corroborated the diagnosis of neurosyphilis with otic and ocular involvement. The patient underwent a 14-day course of intravenous aqueous crystalline penicillin G, resulting in symptom improvement.

Given the prevalence of syphilis and its diverse manifestations, clinicians must maintain a high index of suspicion in patients who engage in high-risk behaviors to facilitate early diagnosis and treatment, which are crucial for optimal outcomes and enhanced prognosis.