A Multisystem Presentation of Secondary Syphilis with Optic Neuritis: A Diagnostic Challenge

Abstract

Syphilis is a re-emerging sexually transmitted infection known for its diverse and often deceptive clinical presentations. It can mimic a wide variety of systemic diseases, resulting in delayed or missed diagnoses. This case report describes a 39-year-old male from the Middle East who presented to ophthalmology with photopsia in the right eye. Over the preceding two months, the patient had experienced multiple unexplained systemic symptoms, started with transient skin rashes, fever, headache with hearing dysfunction followed by small and big joints polyarthritis of one month duration along with blurred vision. The patient disclosed high-risk sexual behavior, raising the suspicion of syphilis. Serological testing confirmed secondary syphilis with optic neuritis. Treatment with intravenous ceftriaxone and oral corticosteroids led to full resolution of the ocular findings, hearing dysfunction and polyarthritis. This case highlights the protean nature of syphilis, the importance of detailed social history, and the need for interdisciplinary awareness to prevent diagnostic delays in complex cases.