Abstract
RATIONALE: Syphilis, a sexually transmitted infection caused by Treponema pallidum, is primarily spread through sexual contact and can lead to severe systemic complications if untreated. PATIENT CONCERNS: A 42-year-old immunocompetent male presented with a nonpruritic papulosquamous rash sparing the palms and soles, which progressed to anterior uveitis and hepatitis. DIAGNOSES: Diagnosis was confirmed by positive rapid plasma reagin and T pallidum hemagglutination assay, alongside histopathological evidence of granulomatous hepatitis on liver biopsy and slit-lamp findings consistent with anterior uveitis. INTERVENTIONS: The patient was hospitalized and treated with intravenous aqueous penicillin G (3 million units every 4 hours for 14 days). OUTCOMES: To our knowledge, this represents the first reported case in Saudi Arabia of secondary syphilis manifesting concurrently with anterior uveitis and hepatitis in an immunocompetent host. LESSONS: The study underscores the importance of considering syphilis in atypical presentations to ensure timely diagnosis and management.