Secondary Syphilis with Ocular Manifestations in Older Adults

Maves, Ryan C; Young, Maile; Fierer, Joshua

doi:10.1086/588483

Cited by 23 publications

(16 citation statements)

References 20 publications

(19 reference statements)

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“…The pathogen usually spreads to the eye through the blood stream. Ocular syphilis can be caused either by the direct invasion of the spirochete or by an allergic reaction in tissues sensitized by the pathogen [15,16].…”

Section: Syphilismentioning

confidence: 99%

“…Almost any part of the eye may be involved in syphilis, including the sclera, cornea, lens, uveal tract, retina, retinal vasculature, optic nerve, pupillomotor pathways, and cranial nerves [15][16][17].…”

Section: Syphilismentioning

confidence: 99%

“…About half of these cases are bilateral [16,19]. Although most commonly presenting in secondary syphilis, iridocyclitis can rarely occur in primary and tertiary syphilis.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Although most commonly presenting in secondary syphilis, iridocyclitis can rarely occur in primary and tertiary syphilis. This condition should be suspected in STD patients with intraocular inflammation resistant to conventional treatment [16,19].…”

Section: Clinical Presentationmentioning

confidence: 99%

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Common Ocular Manifestations of Sexually Transmitted Diseases

Alwadani¹

2018

J Clin Exp Ophthalmol

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This review addresses the most significant ocular manifestations of Sexually Transmitted Diseases (STDs) which both ophthalmologists and sexual health physicians encounter during their practice. STDs to be discussed in this review include Syphilis, Gonorrhea, AIDS and infection with Chlamydiae, Herpes simplex, human papilloma virus, Molluscum contagiosum, Trichomonas vaginalis and infestation with Phthirus pubis.

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Section: Syphilismentioning

confidence: 99%

Section: Syphilismentioning

confidence: 99%

“…About half of these cases are bilateral [16,19]. Although most commonly presenting in secondary syphilis, iridocyclitis can rarely occur in primary and tertiary syphilis.…”

Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

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Common Ocular Manifestations of Sexually Transmitted Diseases

Alwadani¹

2018

J Clin Exp Ophthalmol

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“…La sífilis es una enfermedad infecciosa de transmisión sexual causada por la espiroqueta treponema pallidum, la incidencia de sífilis ha aumentado internacionalmente en la última década debido al aumento de los comportamientos sexuales de riesgo [1], la organización mundial de la salud estima que hubo 10.6 millones de casos de sífilis en 2008 de los cuales el 60% se encontraba en África y el sur este de Asia [2]) Se han descrito 4 etapas en la enfermedad adquirida y puede existir solapamiento entre las cuatro, la primera etapa se caracteriza por una lesión ulcerada en el sitio de entrada del microrganismo, la secundaria ocurre de 2 semanas a meses después de la infección y se asocia a manifestaciones cutáneas, parenquimatosas y constitucionales, posteriormente existe una etapa de latencia temprana (hasta 1 año del contagio) y tardía (después de 1 año del contagio), en las sífilis latente tardía se distinguen tres grupos: asintomáticos sin positividad en las pruebas no treponémicas, asintomático con reactividad en las pruebas no treponémicas y el tercer grupo desarrolla sífilis terciaria en la que ocurren manifestaciones sistémicas, [ 3] La invasión del sistema nervioso ocurre en cualquier etapa de la infección, se puede presentar como neurosifilis temprana: en forma de neurosifilis asintomática, meningitis, neurosifilis meningovascular, y neurosifilis tardía (demencia y tabes dorsal), los síntomas oculares en sífilis son altamente sugestivos de compromiso neurológico [4] , la sífilis ocular tiene múltiples manifestaciones de las cuales la uveítis anterior es el trastorno más frecuente, otras manifestaciones son: queratitis intersticial, cataratas, corioretinitis, glaucoma y neuritis [5] Presentamos un caso en un paciente inmunocompetente que buscó atención por disminución de la agudeza visual y cefalea bilateral, en lo estudios hospitalarios se determinó como diagnostico neuritis óptica en presencia de anticuerpos antifosfolípidos.…”

Section: Introductionunclassified

Neuritis óptica en presencia de anticuerpos antifosfolipidos de origen sifilítico: un diagnostico olvidado

Meneses

Alzate

Quintero

et al. 2018

Rev. Médica Risaralda

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Resumen: la neuritis óptica es infrecuente como manifestación de sífilis ocular, la falta de características típicas genera retraso en el diagnóstico. Describimos el caso de una mujer de 47 años , inmunocompetente con historia de 4 meses de disminución progresiva de la agudeza visual de predominio izquierdo, asociado a dolor, inyección conjuntival y cefalea, al examen físico con visión de bultos y al fondo de ojo con signos de inflamación ocular dentro de la evaluación diagnostica presenta: VDRL y FTA-ABS positivo en suero, positividad de ANAS y anticuerpos anticardiolipinas igG, LCR con VDRL reactivo, se diagnostica neuritis óptica por neurosifilis en presencia de anticuerpos antifosfolipidos, iniciando tratamiento con penicilina cristalina 24 000 000 de unidades día por 14 días. En pacientes con signos de inflamación ocular debe realizarse VDRL, confirmarse con prueba treponemica, y realizar punción lumbar, el tratamiento precoz se asocia a mejora de desenlaces visuales. Palabras clave: sífilis, neurosifilis, sífilis ocular, neuritis óptica, anticuerpos antifosfolipidos Optic neuritis in the presence of antiphospholipid antibodies of syphilitic origin: a forgotten diagnosis Abstract :optic neuritis is uncommon as an ocular syphilis clinical presentation; the lack of typical features generates delay in the diagnosis. We describe the case of a 47-year-old woman, immunocompetent with a 4-month history of left visual acuity progressive of left side reduction, associated with pain, conjunctival injection and headache, physical examination with lumpy vision and fundus with signs of ocular inflammation, within the diagnostic evaluation, serum VDRL, FTA-ABS was reactive, with ANAS and IgG anticardiolipin antibodies serum positivity, lumbar punction was taken with reactive VDRL, optic neuritis by neurosyphilis was diagnosed, with antiphospholipid antibodies cross reactivity , treatment with crystalline penicillin 24 000 000 of units day for 14 days was started . In patients with signs of ocular inflammation, VDRL should be performed, confirmed with a treponemal test, and a lumbar puncture should be performed. Early treatment is associated with improvement of visual outcomes.

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Bilateral ocular perineuritis as the presenting feature of acute syphilis infection

2011

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We describe the case of a 48-year-old man who presented with a 2-month history of recurrent, transient visual obscurations that were not exacerbated by straining or coughing. During this period, he felt unwell with headaches, malaise, and flu-like symptoms. Visual symptoms improved but failed to resolve to two courses of oral amoxicillin prescribed for a presumed upper respiratory tract infection.On examination, he had a normal body mass index. Bilateral disc edema (Fig. 1a) and absent ocular spontaneous venous pulsations were identified. Visual acuity (corrected), color vision, and visual fields were all normal. Slit-lamp examination confirmed disc swelling but was otherwise normal. No other neurological deficits were detected and general medical examination was normal. MRI brain, MR venogram, and MR angiogram were all normal. A lumbar puncture examination revealed an opening pressure of 19 cm of CSF (normal range 12-22 cm of CSF). The CSF white cell was 1, protein 0.32 g/dl (normal range 0.15-0.45) with normal glucose. Positive unmatched oligoclonal bands were detected but there was a normal IgG index.Blood tests, including a full blood count, urea and electrolytes, thyroid function tests, serum protein electrophoresis and anti-nuclear, extractable nuclear antigens, and anti-neutophil cytoplasmic antibodies were normal or negative. An HIV test was negative, however, an initial screen for syphilis demonstrated a positive VDRL and RPR

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Secondary Syphilis with Ocular Manifestations in Older Adults

Cited by 23 publications

References 20 publications

Common Ocular Manifestations of Sexually Transmitted Diseases

Common Ocular Manifestations of Sexually Transmitted Diseases

Neuritis óptica en presencia de anticuerpos antifosfolipidos de origen sifilítico: un diagnostico olvidado

Bilateral ocular perineuritis as the presenting feature of acute syphilis infection

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