Keywords
Neurosyphilis
Human immunodeficiency virus
Panuveitis
Retinal vasculitis
Case report
Categories
How to Cite
Abstract
Ocular inflammation in people living with HIV presents diagnostic challenges when multiple opportunistic infections coexist. Attribution of ocular pathology becomes critical when microbiologic certainty is incomplete.
A man in his 20s with newly diagnosed HIV presented with progressive bilateral visual loss. Examination revealed dense vitritis, optic disc edema, and retinal vasculitis consistent with panuveitis. Syphilis serology was reactive (RPR 1:8; TPHA positive). CSF demonstrated lymphocytic pleocytosis with positive FTA-ABS. Concurrent lymph node biopsy confirmed tuberculous lymphadenitis.
Weight-based antitubercular therapy was initiated, followed by intravenous aqueous penicillin G (24 million units/day for 14 days). Oral prednisolone (1 mg/kg/day) was introduced after antimicrobial coverage and tapered over six weeks. Antiretroviral therapy with tenofovir, lamivudine, and efavirenz was started two weeks after ATT initiation. Visual acuity improved from counting fingers/6-60 to 6-24/6-18 within two weeks, with sustained recovery at six months and declining RPR titers. This case highlights the complexity of diagnostic attribution in HIV-associated uveitis and supports neurosyphilis-based therapy in vision-threatening ocular syphilis despite non-reactive CSF-VDRL.
References
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