Ocular Neurosyphilis in an Immunocompetent Patient Without HIV: A Diagnostic Challenge.

Ocular syphilis is a rare but significant manifestation of Treponema pallidum infection that may present at any stage of the disease. It can affect virtually any ocular structure, with panuveitis being among the most frequent findings. This case report describes a 44-year-old HIV-negative man who presented with progressive unilateral vision loss and was diagnosed with ocular neurosyphilis despite a negative cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test. His diagnosis was supported by positive serum and CSF treponemal antibodies, clinical findings, and treatment response. This case emphasizes the importance of maintaining a high index of suspicion for neurosyphilis even in immunocompetent patients and highlights the diagnostic challenges associated with this condition.