Ocular Syphilis Presenting as a Diagnostic Dilemma: An Educational Case Report and Literature Review

Abstract

Ocular syphilis is a rare manifestation of Treponema pallidum infection that can occur at any stage of disease and may lead to irreversible vision loss if not recognized and treated promptly. Because it can mimic a wide range of ocular inflammatory conditions and may occur without classic systemic features of syphilis, diagnosis is often delayed. Recent epidemiologic data demonstrate a marked rise in syphilitic uveitis cases globally. We report a 44-year-old woman with bipolar disorder, seizure disorder, hepatitis C, and polysubstance use who presented with acute right eye swelling, irritation, and bilateral visual disturbances. Her visual symptoms were repeatedly attributed to allergic irritation, delaying diagnosis.Ophthalmologic evaluation demonstrated mild ocular inflammation, and serologic testing confirmed syphilis with positive treponemal and nontreponemal results. Despite multiple interruptions in therapy, she ultimately completed treatment with intravenous penicillin G in accordance with current guidelines. This case highlights the importance of maintaining a high index of suspicion for ocular syphilis, obtaining timely serologic testing, and addressing barriers to treatment adherence through coordinated multidisciplinary care.

Bangladesh J Medicine 2026; 37(2): 161-164