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Case report
Secondary syphilis presenting with acute unilateral vision loss and a widespread maculopapular rash
  1. Gareth Trevelyan,
  2. Kartik Kumar,
  3. Georgina K Russell and
  4. Melissa Wickremasinghe
  1. Department of Respiratory Medicine, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Gareth Trevelyan, g.trevelyan{at}


Syphilis infection has shown a marked resurgence over the past several years. Ocular involvement is a rare complication of syphilis, occurring in approximately 1% of cases. We present the case of a man in his 50s who presented to hospital with acute unilateral vision loss and a widespread maculopapular rash. Ophthalmological examination showed unilateral optic disc swelling and bilateral vitritis. Intracranial imaging revealed no acute pathology. Initial blood tests were normal apart from mildly elevated inflammatory markers. A comprehensive autoimmune and infection screen revealed positive syphilis serology. The patient was subsequently treated for syphilis with ocular involvement with a course of intravenous benzylpenicillin, resulting in rapid symptomatic improvement. This case highlighted the importance of considering syphilis infection as part of the differential diagnosis for unexplained multisystemic symptoms, such as loss of vision in combination with dermatological involvement.

  • syphilis
  • ophthalmology
  • dermatology

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  • Contributors All authors were directly involved in the clinical care of the described case and in planning this article. GT and KK drafted the initial manuscript and contributed equally to this paper. GKR and MW revised the manuscript for content and contributed equally to this paper. All authors approved the version of the manuscript that was submitted for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.