Ocular syphilis unmasked following intravitreal triamcinolone injection

To report intravitreal triamcinolone (IVTA)-induced unmasking of ocular syphilis.

Two case reports.

A homosexual, diabetic male with macular edema treated with bilateral IVTA and a male with bilateral panuveitis and macular edema who underwent vitrectomy and IVTA. Both developed occlusive retinal vasculitis and panuveitis postinjection. Syphilis serology was positive although both denied previous symptoms.

Intramuscular penicillin lead to resolution of inflammation but both sustained severe loss of vision. Cause-and-effect relationship demonstrated between IVTA and reactivation of syphilis.

Intravitreal corticosteroid can modulate the immune response to intraocular syphilis; vigilance is required, particularly in high-risk patients.