Syphilitic retinitis and panuveitis simulating acute retinal necrosis: case report

Zambon, Felipi; Silva, Frederico Lírio Nascimento; Cavalcante, Adhele Furlani de Sá; Nakashima, Yoshitaka; Helal, John

doi:10.1590/s0004-27492010000300016

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…On review of literature, we found a similar case reported by Zambon F et al [15], where a case of syphilitic uveitis was misdiagnosed as acute retinal necrosis (ARN) and started on antivirals and oral corticosteroids leading to no light perception in the affected eye.…”

Section: Discussionsupporting

confidence: 70%

Syphilitic uveitis misdiagnosed as viral retinitis—a misleading history

Agarwal

Ranjan

Paul

et al. 2018

J Ophthal Inflamm Infect

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BackgroundSyphilitic uveitis is an infective uveitis and a great mimicker. Misdiagnosis can lead to delay in the specific treatment resulting in deterioration of uveitis and loss of vision.FindingsA 38-year-old unmarried female presented with pain, redness, and blurring of vision in the left eye for the last 5 days. She denied history of any sexual exposure in the past. Anterior segment examination of the right eye was normal and the left eye showed keratic precipitates with anterior chamber cells and iris pigments on anterior lens capsule. Fundus examination of the right eye showed a hyperemic disc with posterior placoid retinochoroiditis and the left eye showed dense vitritis, hyperemic disc, and superficial retinal precipitates. She was misdiagnosed as viral retinitis elsewhere and started on antivirals with oral corticosteroids which resulted in deterioration of uveitis and progression to bilateral involvement. Further systemic investigations confirmed the diagnosis of syphilis and human immunodeficiency virus infection. She was then started on anti-syphilitic and anti-retroviral therapy which resulted in restoration of the vision in one eye.ConclusionSyphilitic uveitis does not occur in primary disease and is common in secondary and early latent phase of syphilis. History given by the patient is often contributory however at times can be misleading. A high clinical suspicion and thorough investigation is necessary for the correct diagnosis and timely intervention in preventing loss of vision.

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Section: Discussionsupporting

confidence: 70%

Syphilitic uveitis misdiagnosed as viral retinitis—a misleading history

Agarwal

Ranjan

Paul

et al. 2018

J Ophthal Inflamm Infect

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“…Rarely, a much lower latency was noted. In four cases, two immunocompetent patients and two with HIV infection respectively, the chancre had developed only a few months before or even simultaneously to NS, which in all cases took the appearance of a meningitis with ocular or auditory involvement . In eight other patients, seven of them HIV‐positive, a maculopapular rash developed at the same time or a few weeks before the neurological manifestations, which were parenchymal in three cases, meningitical in three cases, meningovascular and gummatous in one respectively …”

Section: Resultsmentioning

confidence: 95%

“…The information about the history of the patients' therapy was scarce as well. In particular, only six patients (2%) reported a certain previous treatment for syphilis, but for two of them it was unclear whether such therapy was completed and even if it was a standard one . A total of 171 patients, that is, 60%, denied the occurrence of previous skin or mucous lesions; so we must assume that they have not received any therapy for early syphilis.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, the suggestion that a standard therapy with penicillin G benzathine (BPG) in early syphilis may not be sufficient to prevent NS, has been already advanced and supported by cases of BPG failures and by late complications in immunocompetent patients adequately treated for early disease . In a recent study, 17 patients progressed to NS despite appropriate treatments and serological response understood as of a fourfold decrease in their RPR titres within 6 months from therapy .…”

Section: Discussionmentioning

confidence: 99%

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Changes in neurosyphilis presentation: a survey on 286 patients

Drago

Merlo

Ciccarese

et al. 2016

Acad Dermatol Venereol

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Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.

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“…Moreover, during the follow up, long-term complications have never been observed and no systemic alterations related to syphilis have been detected at echocardiography or at neurologic examination in patients treated with the enhanced regimen. These data are very encouraging considering that in another study, neurologic and cardiovascular abnormalities have been found in patients with early syphilis over-treated for 2 consecutive years with a total of 60 MU of BPG already after 5 years of followup (Zambon et al 2010 ; Dietrich et al 2014 ). In fact, 35 % of them revealed neurologic alterations and 19 % cardiovascular complications, confirming that BPG alone may be inadequate, in some patients, in preventing late complications (Drago et al 2012 ; Cheng et al 2014 ).…”

Section: Discussionmentioning

confidence: 74%

Syphilitic aortic aneurysm with a pulmonary lesion: a case report and literature view

et al. 2016

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IntroductionSyphilitic aortic aneurysm (SAA) is caused by tertiary stage of syphilis infection. As the wide application of penicillin, this complication is becoming rarer than before. The SAA with lung cancer is a very rare disease in patient.Case descriptionA 55-year-old male was admitted to the hospital complaining “progressive hoarseness for 3 months” and the patient has been diagnosed with syphilis after specific blood exams, computed tomography angiography (CTA) and 3dimensional (3D) reconstructions of cardiac vessels. Chest computed tomography displayed an anomalous soft tissue mass with slightly lobular borders in the peripheral segment of the left lower lobe. According to the aneurysm’s and lung neoplasm’s location, several procedures could be selected such as aneurysm resection with artificial graft replacement or endovascular stenting under angiography. Then, the lesion was removed by lobectomy using video-assisted thoracic surgery.Discussion and EvaluationCardiovascular syphilis remains a major cause of ascending aortic aneurysm. The clinical manifestations of patients with syphilis aortic aneurysm could vary. Aortic imaging is necessary to confirm the diagnosis and to determine the anatomic extent of the aneurysm. The differential diagnosis of the lesion in the pulmonary is mostly the tumor like pulmonary lesion, Pulmonary syphilis. Some studies showed that thoracic aortic aneurysm has been reduced by using penicillin. However, penicillin therapy alone is not always sufficient in recent years. The serologic response to treatment is more significant and faster in patients treated with the enhanced regimen compared to patients treated with the standard penicillin regimen. ConclusionsSyphilitic aortic aneurysm with lung cancer is a rare disease in patient. Chest CT and CTA scans are able to indicate the presence of SAA. Pathological analysis is an effective method to clarify the diagnosis of the lung lesion. The interventional therapy and surgery are regular treatment method for SAA and pulmonary neoplasm.

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Syphilitic retinitis and panuveitis simulating acute retinal necrosis: case report

Cited by 7 publications

References 10 publications

Syphilitic uveitis misdiagnosed as viral retinitis—a misleading history

Syphilitic uveitis misdiagnosed as viral retinitis—a misleading history

Changes in neurosyphilis presentation: a survey on 286 patients

Syphilitic aortic aneurysm with a pulmonary lesion: a case report and literature view

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