Perforating Peripheral Ulcerative Keratitis in Syphilis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Dermatology

Background:

• Syphilis, a systemic infection, can present with diverse ocular manifestations.
• Peripheral ulcerative keratitis (PUK) is a severe inflammatory condition affecting the cornea.
• Ocular syphilis requires prompt diagnosis and treatment to prevent vision loss.

Observation:

• A case report of a patient with multiple sexual partners presenting with bilateral PUK, unilateral corneal perforation, and a pustular rash.
• Diagnostic workup revealed co-infection with syphilis, herpes simplex virus (HSV), and human immunodeficiency virus (HIV), alongside positive autoantibody tests.
• The patient's ocular findings showed improvement following treatment directed at syphilis.

Findings:

• This case represents the first reported instance of corneal perforation associated with syphilis.
• Bilateral PUK in the context of syphilis has been documented in only one previous report.
• The clinical presentation underscores the potential for severe and unusual ocular complications in advanced syphilis.

Implications:

• This case highlights the importance of considering syphilis in the differential diagnosis of severe ulcerative keratitis, especially in patients with risk factors.
• Ophthalmologists and infectious disease specialists should be aware of the potential for corneal perforation as a rare but serious complication of ocular syphilis.
• Early recognition and appropriate management of syphilis are crucial for preventing irreversible visual impairment.