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Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis

Christy Elizabeth Benson1, Mohamed Kamel Soliman2, Alexander Knezevic1

  • 1Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA.

Journal of Ophthalmic Inflammation and Infection
|June 13, 2015
PubMed
Abstract

Insights

Ocular syphilis, a rising concern, can present unusually. Early diagnosis requires a high index of suspicion, and prompt intravenous penicillin G treatment effectively resolves this Treponema pallidum infection.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Syphilis, caused by Treponema pallidum, is a multisystem infection with a >75% incidence rise in the US since 2000.
  • Ocular involvement is common in syphilis, often manifesting as posterior uveitis.
  • This case highlights an unusual presentation of bilateral panuveitis with papillitis and unilateral chorioretinitis.

Purpose of the Study:

  • To report a rare case of ocular syphilis with an atypical presentation.
  • To emphasize the importance of early diagnosis and prompt treatment of ocular syphilis.
  • To review the diagnostic challenges and management of syphilitic uveitis.

Main Methods:

  • Retrospective case report with literature review.
  • Clinical examination including dilated funduscopy, fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography.
  • Laboratory confirmation using rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) tests.

Main Results:

  • A 39-year-old female presented with bilateral ocular flashes and unilateral eye pain.
  • Fundus examination revealed bilateral optic disc edema and unilateral peripheral retinal elevation/whitening.
  • Positive RPR and FTA-Abs confirmed syphilitic uveitis.

Conclusions:

  • Ocular manifestations can be the initial sign of syphilis, posing diagnostic challenges.
  • A high index of suspicion is crucial for the early diagnosis of ocular syphilis.
  • Intravenous penicillin G is effective for treating ocular syphilis, leading to infection resolution.
Keywords:
ChorioretinitisPanuveitisPapillitisRetinitisSyphilisUveitis

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