(645) Secondary Syphilis with Ocular and Otologic Involvement: The Importance of Clinical Suspicion - A Case Report

Introduction Syphilis is a systemic infection caused by Treponema pallidum, mostly transmitted through sexual contact. The global prevalence of syphilis has been increasing in recent decades. This disease evolves four clinical stages: primary, secondary, latent, and tertiary, comprising a broad spectrum of clinical manifestations that often delay diagnosis. A maculopapular rash is the most common form of secondary syphilis, typically involving the trunk and extremities. Otosyphilis and ocular syphilis are uncommon complications that can be present at any stage and may lead to irreversible sequelae when they are not promptly recognized and treated. Sensorineural hearing loss and uveitis are the most frequent presentations of otosyphilis and ocular syphilis, respectively. Serologic testing is crucial for diagnosis, and the treatment for these forms of disease consists of intravenous penicillin G for 10 to 14 days, following the neurosyphilis regimen. Serologic testing is crucial for diagnosis, and treatment for these disease forms consists of intravenous penicillin G for 10 to 14 days, following the neurosyphilis regimen. Objective To describe a clinical case to illustrate the diagnostic challenges of secondary syphilis with otologic and ocular involvement and to highlight the importance of early recognition of atypical manifestations to prevent irreversible sequelae. Methods A descriptive case report of a 37-year-old male with a delayed diagnosis of secondary syphilis with otologic and ophthalmologic manifestations. Clinical data from primary care consultations, hospital attendances, and inpatient stay were collected to summarize the diagnostic work-up, treatment, and clinical course. Informed consent was obtained from the patient. Relevant literature was reviewed to provide contextual background and support the discussion. Results A 37-year-old male, with no significant medical history, initially presented to primary care with bilateral otalgia, mild fever, and progressive right-sided hearing loss. He was treated symptomatically for presumed otitis. Over the following weeks, he developed a generalized, non-pruritic maculopapular rash affecting the trunk, neck, upper limbs, and thighs, but sparing the palms and soles, followed by bilateral ocular hyperemia and decreased visual acuity. He was reassessed in primary care and the emergency department, where ophthalmologic evaluation was initially interpreted as conjunctivitis. One month later, with persistence of symptoms, he returned to the emergency department, where bilateral anterior uveitis was identified. Given the systemic involvement, serologic testing was performed, revealing positive Venereal Disease Research Laboratory (VDRL) and Treponema pallidum hemagglutination assay (TPHA) results, confirming secondary syphilis. Human immunodeficiency virus testing was negative, and the patient denied any prior genital lesions. He was admitted for management with intravenous penicillin G for 14 days. At one-month follow-up, cutaneous and ocular manifestations had completely resolved, while auditory symptoms showed only partial improvement. Conclusions This case demonstrates how secondary syphilis can mimic other conditions and delay diagnosis, especially with ocular or otologic involvement. Clinical suspicion is crucial in patients with unexplained sensorineural hearing loss, uveitis or systemic rash for prompt diagnosis and treatment, to prevent irreversible complications and limit disease transmission. Disclosure No