More than meets the eye: Monocular syphilis in an HIV-negative patient

Abstract

A 50-year old heterosexual male presented with discomfort in his left eye and abnormal behavior. Physical examination showed a red eye suggestive of uveitis. He was found to have a reactive rapid plasma reagin (RPR) test in high titer and a cerebrospinal fluid (CSF) pleocytosis, with a reactive Venereal Disease Research Laboratory (VDRL) titer in the CSF. Testing for human immunodeficiency virus (HIV)-1 and HIV-2 was negative. He was diagnosed with ocular/neurosyphilis and treated with intravenous (IV) penicillin G for 14 days followed by an intramuscular injection of benzathine penicillin, with complete resolution of ocular findings and behavioral changes. This report illustrates an unusual presentation of ocular/neurosyphilis in an HIV-negative i