Hypophysitis in a HIV-Positive Patient With a Syphilis Latent Infection.

Background: Hypophysitis is a rare inflammatory disorder of the pituitary gland that may result from primary autoimmune disease or secondary causes such as infection. In people living with HIV, coinfection with Methods: Written informed consent was obtained from the patient, with all personal identifiers removed, in compliance with the CARE guidelines. Presentation: A 50-year-old man with known HIV infection and a history of latent syphilis presented to the emergency department with headache, asthenia, adynamia, and visual decline. Laboratory evaluation demonstrated a positive rapid plasma reagin (RPR) test at 1:64, a CD4 count of 391 cells/µL, a viral load of 40,000 copies/mL, and biochemical evidence of panhypopituitarism. Ophthalmologic assessment revealed bitemporal hemianopia. Brain MRI identified a sellar mass compressing the optic chiasm, consistent with an infiltrative pituitary process. The patient was treated with intravenous penicillin and hormone replacement therapy. A follow-up MRI showed a reduction in pituitary size, and 1 month later he reported a resolution of neurological symptoms and a marked improvement in visual acuity. Conclusions: The present description illustrates an uncommon manifestation of syphilis-related hypophysitis in an HIV-positive individual, managed successfully with antibiotics and hormonal supplementation. Although rarely reported in literature, syphilitic hypophysitis should be considered in HIV-infected patients presenting with endocrine deficits and visual field abnormalities. With rising rates of HIV-syphilis coinfection, clinicians may encounter this entity more frequently than previously appreciated.