An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report

Syphilis represents a global health issue, with an estimated 12 million people infected every year; this infectious disease is prevalent in Africa, Asia and South America. In European countries, syphilis is considered a re-emerging infectious pathology. The European Centre for Disease Prevention and Control (ECDC) has reported that the overall number of syphilis cases increased substantially in most Western European countries between 1998 and 2007, mostly among men [1].In recent years, most of the reported syphilis cases have been associated with HIV infection [2-5].In 2007, Italy registered 720 cases of syphilis, 561 among males. No data exist about migrants. The complexity of syphilis diagnosis based on clinical and serological findings is already subject of scientific discussion, and is leading to the revision of treatment guidelines [6,7].Severe vision loss due to Treponema pallidum causing syphilis is a rare manifestation of this disease in the antibiotic era, especially in developed countries [8,9]. The most common ocular manifestation of this infection is uveitis, occurring in 2.5 to 5% of patients with tertiary syphilis [10]. Other ocular manifestations are focal retinitis, papillitis, iritis, keratic precipitates, periphlebitis, vitritis, and serous and exudative retinal detachment [11,12].The ability of syphilis to mimic different ocular disorders can lead to misdiagnosis and delay in the administration of appropriate antimicrobial therapy, particularly in persons who receive inadequate penicillin therapy. To the best of our knowledge, few cases of unusual neurosyphilis presentation have been reported in the literature. In the present work, a case of ocular and atypical neurosyphilis in an HIV-negative patient is described.A 38-year-old Brazilian transgender patient attending the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP), presented with a sudden decrease of visual acuity in the left eye (visual best-corrected