The Great Masquerader: Syphilis Mimicking Papilledema and Traction Alopecia

• Published in: Curēus (Palo Alto, CA) Vol. 12; no. 3; p. e7391
• Main Authors: McNally, Michelle A, Murira, Angela, Dillard, Christen M, Aisenberg, Gabriel
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 24-03-2020; Cureus
• Subjects: Alopecia; Baldness; Case reports; Dermatology; Edema; Hair loss; Headaches; HIV; Human immunodeficiency virus; Infectious Disease; Laboratories; Ophthalmology; Optic nerve; Patients; Penicillin; Syphilis; Womens health; United States > US; traction alopecia; papilledema; syphilis; syphilitic alopecia; papillitis
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.7391

Syphilis is often referred to as "the great masquerader," as it may present with a wide array of clinical symptoms and may mimic a variety of other diseases making diagnosis challenging. We report the case of a young, married woman who presented with a one-month history of significant hair loss, unintentional weight loss, blurred vision, and intermittent headaches. In addition, she endorsed positional dizziness and intermittent arthralgias. Physical exam was only remarkable for a non-scarring alopecia over the frontal marginal hairline and optic disc edema on fundoscopic exam. Laboratory tests were largely unremarkable except for a rapid plasma reagin titer of 1:128 and a positive confirmatory treponemal test. Cerebrospinal fluid analysis showed lymphocytic pleocytosis and negative Venereal Disease Research Laboratory test. Opening pressure was 15 cm H
O twice, ruling out papilledema. She was treated with 4 million units of intravenous penicillin every four hours for 14 days, and her symptoms improved. A diagnosis of syphilis should remain high on the differential diagnosis in patients with unexplained hair loss or ocular abnormalities.