Neuroretinitis Syphilis in Human Immunodeficiency Virus-Infected Patient

Abstract

BACKGROUND: In HIV-infected patient who accompanied by syphilis often difficult to diagnose and difficult to treat. The aim is to diagnostics understanding and to optimise the management and response therapy in patients with neuroretinitis syphilis in HIV-infected patients. CASE PRESENTATION: A 53-years old, bisexual, male patient whose initial presentation was a blurry vision on the left eye. History of a painless genital lesion, HIV infection (+) on ARV therapy. The visual acuity of hand movement (HM), RAPD (+), with vitreous opacities and optic disc swelling. The OCT RNFL showed neural layer thickening in all areas. VEP showed increased P100 latency, normal head and orbital CT scan. High VDRL and TPHA titer. Lumbar puncture examination showed non-reactive VDRL. Treated with topical prednisolone eye drops, oral neurotropic vitamin, and intramuscular injection of Benzathine Penicillin G. Diagnosed with OS neuroretinitis et causa syphilis infection, HIV stage II on HAART. Follow up in 2 months, the visual acuity improved, and serology post-therapy VDRL was decreased. CONCLUSION: High accuracy is needed for screening signs and symptoms in syphilis patients because of the varied clinical manifestations. Ocular syphilis manifestation in HIV has a higher risk for neurologic complications and the risk of failing treatment with the standard regimen.

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

“…The most common manifestations are panuveitis or posterior uveitis, followed by interstitial keratitis, chorioretinitis, neuroretinitis, retinal vasculitis, and neuropathies [9]. The clinical presentation of neuroretinitis is usually of decline in visual acuity followed by central or cecocentral scotomas [10]. This was identical to the presenting symptoms in our patient with a subsequent diagnosis of neuroretinitis on ophthalmological evaluation.…”

Ocular Syphilis: A Case of Progressive Bilateral Panuveitis

“…4,5,7 Ocular manifestations may be unilateral or bilateral. 8 Panuveitis due to syphilis can present with either a non-granulomatous or granulomatous anterior uveitis, have iris nodules, and be associated with increased intraocular pressure, 5 as demonstrated in Table I.…”

Commentary: Neuroretinitis, frosted branch angiitis and paracentral acute middle maculopathy in a young female

“…Typically, the term neuroretinitis is reserved for the findings of disc edema and macular star seen commonly in cat-scratch disease, toxoplasmosis, herpes simplex retinitis, Lyme disease, and has been described before in syphilitic uveitis as well. [ 4 ]…”