Vascularized Iris Mass as Sentinel Manifestation of Syphilis in Patient with HIV Infection, Spain, 2025.

Vascularized iris masses are rare, yet highly suggestive of syphilis. We report a 51-year-old man in Spain with HIV infection who had painful vision loss, rash, and an iris mass. Laboratory testing confirmed syphilis; ocular manifestations resolved with intravenous ceftriaxone and penicillin. Early recognition of syphilis can prevent vision loss and neurologic complications.