Ocular syphilis masquerading as CMV retinitis in a transplanted patient

Background: Syphilis has historically been referred to as “the great imitator”, for the extent of disease manifestations secondary to infection. Ocular manifestations include a wide range of intra-ocular inflammation. Methods: In this study, we report the case of a 52 years-old male patient with syphilitic hemorrhagic necrotizing retinitis. Results: The patient presented to the emergency room for rapid and progressive vision loss and ocular redness lasting three weeks and was under immunosuppressive treatment. The diagnosis was syphilitic hemorrhagic necrotizing retinitis mimicking the typical clinical picture of retinitis caused by Cytomegalovirus infection in immunocompromised patients. Conclusions: The presented case highlights the need to consider ocular syphilis as a great masquerader even in the presence of atypical presentations such as hemorrhagic retinitis. Syphilis should be tested for treponemal and non-treponemal tests, and it should be ruled out as an etiological agent in every case of new-onset intra-ocular inflammation.