Syphilis, an infection caused by Treponema pallidum, is well known for its ability to mimic other diseases across various organ systems, complicating timely diagnosis. Ocular syphilis, though rare, is a severe manifestation that can closely resemble other eye conditions, making early identification challenging. When conventional treatments fail to improve symptoms, considering syphilis in the differential diagnosis becomes crucial to avoid further complications. We present the case of a 64-year-old woman who initially presented with progressive blurred vision, redness, and photophobia. She was initially treated for suspected endogenous endophthalmitis with broad-spectrum antibiotics, but her condition did not improve. Further diagnostic workup, including serological testing, revealed a positive result for T. pallidum, leading to a diagnosis of ocular neurosyphilis. Treatment with intravenous penicillin and corticosteroids resulted in a gradual improvement in her symptoms. This case highlights the complexity of diagnosing ocular syphilis, which can mimic more common ocular infections and inflammatory conditions. A high index of suspicion is necessary when conventional treatments are ineffective, as early diagnosis and appropriate intervention are critical to preventing irreversible damage, such as permanent vision loss. Comprehensive diagnostic testing, including serological analysis, is essential to ensure accurate identification and management of this condition.
Keywords: diagnostic challenges; endophthalmitis; neurosyphilis; ocular syphilis; syphilis; treponema pallidum.
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