We describe a case of an HIV-negative man who was mistakenly diagnosed as having systemic
sarcoidosis, which led to a delay in diagnosing
tertiary syphilis and
Kaposi sarcoma (KS). The patient presented initially with scrotal swelling and leg oedema. Initial blood tests were unremarkable and HIV testing was negative. The patient then developed unilateral limb weakness. Computed tomography showed lung lesions and hilar
lymphadenopathy, while magnetic resonance imaging showed an increased signal in the cervical cord. Serum
angiotensin-converting enzyme was raised, and a diagnosis of
sarcoidosis was made and the patient started on
steroids. Subsequently, his clinical symptoms and radiological abnormalities improved. However, he then developed progressive neurological deficits over several weeks, together with
uveitis and cutaneous lesions. A
uveitis screen showed a raised
venereal disease research laboratory test titre and the cause of his multisystemic symptoms was revisited. He was diagnosed with
tertiary syphilis and treated with
antibiotics. Dermatologists reviewed the skin lesions and diagnosed KS, which was confirmed with biopsies. The patient's neurological deficit remains.
Syphilis should be considered in the differential diagnosis of any patient presenting with neurological problems, skin lesions or symptoms affecting multiple systems. Co-existing KS presented an extra therapeutic challenge in this case.