Otosyphilis and Malignant Syphilis in a Human Immunodeficiency Virus–Infected Patient: A Case of Bilateral Hearing Loss with Complete Recovery Following Ceftriaxone Therapy – Case Report

Pati Aji Achdiat, Rievanda Ayu Natasya, Eva Krishna Sutedja, Chaerani Pratiwi Firdaus, Ayu Adzani Sabila, Retno Hesty Maharani Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Email [email protected] Retno Hesty Maharani, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Email [email protected]: Syphilis is characterized by diverse manifestations, including rare complications such as otosyphilis and malignant syphilis, particularly in immunocompromised individuals.Case Presentation: This study reported a case of a 40-year-old Human Immunodeficiency Virus (HIV)-positive male with bilateral sensorineural hearing loss (SNHL) and disseminated ulceronodular skin lesions. Serological testing confirmed active Treponema pallidum infection with a venereal disease research laboratory (VDRL) titer of 1:64. Dermatological results were consistent with malignant syphilis, a rare and aggressive variant of secondary syphilis. Audiological assessment showed mild bilateral SNHL, while cerebrospinal fluid analysis was insignificant. Although histopathological confirmation was not performed due to rapid clinical improvement, a presumptive diagnosis of otosyphilis was made.Treatment and Outcome: The patient was treated with intramuscular ceftriaxone 2 grams daily for 14 days as an alternative to penicillin due to accessibility constraints and preference. This led to complete resolution of hearing loss, regression of cutaneous lesions, and a significant clinical serological response, including VDRL seroconversion at 6 months. The treatment did not produce Jarisch–Herxheimer reaction, showing good tolerance and supporting ceftriaxone effectiveness as an alternative therapy in HIV-associated syphilis.Conclusion: This case study underscores the importance of early recognition and treatment of otosyphilis and malignant syphilis in HIV-infected individuals. Ceftriaxone may serve as an effective alternative regimen to penicillin, achieving both clinical and serological recovery. Moreover, routine screening for otologic symptoms in patient with syphilis is critical to prevent irreversible complications. The limitations include the absence of histopathology and CSF analysis conducted after therapy initiation.Keywords: otosyphilis, malignant syphilis, HIV, sensorineural hearing loss, ceftriaxone, secondary syphilis