Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis

Abstract

BackgroundSyphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis.FindingsThis is a retrospective case report with literature review. A 39-year-old Caucasian female presented with a 2-week history of bilateral ocular flashes and left eye pain. Dilated fundus examination revealed mild optic disc edema in both eyes, the right eye more than the left. In the left eye, there was an area of retinal elevation and whitening involving the peripheral retina. Fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography were performed, and laboratory tests were ordered based on the clinical presentation. After rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were positive, syphilitic uveitis was confirmed, and the patient was admitted for a 14-day course of high-dose intravenous penicillin G.ConclusionsThe first signs and symptoms of syphilis may be ocular, which can lead to a diagnostic challenge. A high index of suspicion is the key for early diagnosis of ocular syphilis. Prompt treatment with intravenous penicillin G is highly effective in resolving the infection.

Spectral optical coherence tomography findings in an adult patient with syphilitic bilateral posterior uveitis and unilateral punctate inner retinitis

“…The most common presentation of syphilis in the eye is uveitis. 5 Uveitis develops in about 10% of cases of secondary syphilis and in up to 5% of cases who progress to the tertiary stage. 6 …”

“…Syphilitic ocular inflammation may be unilateral or bilateral and it can involve the anterior, intermediate, or posterior segment. 5 The predominant type of syphilitic uveitis diverges in different case series. 6 , 7 , 8 …”

Clinical Manifestations and Treatment Outcomes of Syphilitic Uveitis in a Chinese Population

“…Syphilis uveitis is one of the so-called masquerade syndromes in its ability to mimic various diseases such as atypical presentations of Vogt-Koyanagi-Harada disease, viral retinitis, sarcoidosis, tuberculosis, and intraocular lymphoma [ 18 ]. Although the presentation may be various in different patients, certain features were characteristic for syphilitic uveitis, such as posterior placoid chorioretinitis and dense preretinal vitreous opacity.…”

Eyes As the Window to Syphilis: A Rare Case of Ocular Syphilis As the Initial Presentation of Syphilis

“…HIV-infected patients in particular are more prone to develop NS [5]. Ocular involvement is very rare in NS and accounts for only 1%-5% of the cases in the United States [6,7]. We report the case of a patient who presented with a "black spot" in his vision and was found to have ocular syphilis and NS.…”