Nodular syphilitic scleritis masquerading as an ocular tumor

Area of Science:

• Ophthalmology
• Infectious Diseases
• Rheumatology

Background:

• Scleritis can be the initial manifestation of systemic diseases, including autoimmune and infectious disorders.
• Corticosteroids are standard for immune-mediated scleritis but can worsen infectious causes.
• Ruling out infectious etiologies is critical before initiating treatment for scleritis.

Purpose of the Study:

• To highlight a rare case of nodular scleritis caused by syphilis.
• To emphasize the importance of considering syphilis in the differential diagnosis of nodular scleritis.
• To advocate for routine syphilis screening in patients with scleritis.

Main Methods:

• Case presentation of a 47-year-old male with nodular scleritis.
• Diagnostic workup including Venereal Disease Research Laboratory (VDRL), Rapid Plasma Reagin (RPR), and Treponema pallidum hemagglutination assay (TPHA) tests.
• Ocular imaging with Ultrabiomicroscopy (UBM) and ultrasound to rule out intraocular tumor.

Main Results:

• The patient presented with nodular scleritis, initially misdiagnosed as an ocular tumor.
• Laboratory tests confirmed active syphilis (positive VDRL, RPR, TPHA).
• Ocular imaging excluded an intraocular tumor, and the patient responded well to penicillin treatment.

Conclusions:

• Syphilis can present atypically as nodular scleritis, mimicking an ocular tumor.
• Syphilis should be included in the etiological workup for nodular scleritis.
• Routine syphilis testing is recommended for patients presenting with scleritis.