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Syphilitic retinitis with focal inflammatory accumulations
Shantan Reddy1, Emmett T Cunningham, Richard F Spaide
1Department of Ophthalmology, New York University School of Medicine, New York, USA.
Summary
This case study highlights an unusual ocular presentation of syphilis in an HIV-positive patient. Highly active antiretroviral therapy may have contributed to an exaggerated immune response to the infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- A 42-year-old human immunodeficiency virus (HIV)-positive male with prior immune reconstitution on highly active antiretroviral therapy (HAART) was evaluated for suspected cytomegalovirus retinitis.
- Ocular syphilis can present with diverse manifestations, particularly in immunocompromised individuals.
Observation:
- The patient presented with atypical juxtapapillary and preretinal white lesions, along with peripheral ground-glass opacification of the retina.
- These ocular findings were initially concerning for viral retinitis.
Findings:
- Prompt resolution of the retinal lesions was observed following treatment for syphilitic retinitis.
- The clinical presentation suggested an exaggerated immune response to ocular syphilis.
Implications:
- This case underscores the importance of considering syphilis in the differential diagnosis of atypical retinitis in HIV patients on HAART.
- The findings suggest that immune reconstitution by HAART might potentiate an exaggerated inflammatory response to opportunistic infections like syphilis.
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