Malignant Syphilis with Ocular Involvement and Organism-Depleted

Diagnosis and treatment of syphilis are challenging because of the condition’s diverse clinical symptoms, histopatholog-ical variance, and the lack of definite tests for treatment follow-up. We report a case of secondary pustular-ulcerative malignant syphilis with ocular involvement in a human im-munodeficiency virus–infected patient. It was striking to find that ulcerative lesions can be highly organism depleted. Case report. A 45-year-old, HIV-infected man who has sex with men presented with progressive skin eruptions of the right side of his face, scalp, and arm. Symptoms were first noticed 3 months before presentation and were followed 2 weeks later by eye involvement, with a progressive scleral nodule and red eye. The patient reported experiencing malaise and arthralgias of varying intensity of the feet, wrists, elbows, and knees. At the time of symptom onset, the patient was receiving treatmen