Syphilis Uveitis: A Case of Occam’s Razor, Hickam’s Dictum, and Crabtree’s Bludgeon

This report discusses a case of diagnosing neurosyphilis in a non-classical presentation with confounding test results needing a deliberate and multidisciplinary diagnostic approach. A 38-year-old immunocompetent male presented with uveitis and a skin rash. Although serology was positive for syphilis (rapid plasma reagin 1:128), it was also positive for tuberculosis, and a dermatology consult identified the rash as psoriasis, creating a complex diagnostic picture. Based on a high suspicion of ocular syphilis, the patient received intravenous penicillin, which led to the complete resolution of his ocular symptoms and a serologically confirmed cure. This case of an ophthalmic masquerading disease was complicated by misleading clinical signs and a coexisting positive serology, serving as a reminder to maintain a broad differential diagnosis and be systematic in workup and management in order to optimize clinical outcomes.