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

The article describes a case of a 51-year-old man from Spain with HIV infection who presented with painful vision loss, facial rash, and an iris mass. Laboratory tests confirmed syphilis with a rapid plasma regain titer of 1:256. The patient had a CD4+ cell count of 300 cells/μL and HIV viral load of 25 copies/mL. Imaging studies using ultrasound biomicroscopy and optical coherence tomography revealed a vascularized iris mass with ciliary body involvement. Ocular manifestations resolved following treatment with intravenous ceftriaxone and penicillin. The article emphasizes that early recognition of syphilis can prevent vision loss and neurologic complications.