Mixed-pattern, essential syphilitic alopecia, uveitis, and papillitis in an immunocompetent patient with neurosyphilis

Syphilitic alopecia (SA) and ocular syphilis (OS) are rare manifestations of syphilis, typically reported together in immunocompromised patients. We present a unique case of mixed-pattern, essential, SA of the scalp and OS in the form of anterior uveitis in an otherwise immunocompetent, HIV-negative, 46-year-old female. Briefly, the patient initially presented with sudden-onset scalp hair loss that was initially diagnosed as atypical alopecia areata but failed to respond to typical alopecia areata-directed therapy. Concurrently, the patient developed ocular and neurologic symptoms, and the diagnosis of syphilis was rendered based on the constellation of clinical findings and cerebrospinal fluid/serologic testing. Syphilis-directed therapy resulted in the reversal of ocular and neurologic symptoms, as well as rapid scalp hair regrowth. This case highlights the importance of considering diagnosis of syphilis in the differential diagnosis for atypical alopecia.