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Ocular syphilis in an immunocompetent man.

Lundy R Mckibbin1, Kamran Kadkhoda2, Rodney Kellen3

  • 1Department of Clinical Immunology and Allergy, Western University, London, Ontario, Canada.

Idcases
|June 13, 2020
PubMed
Summary

Ocular syphilis, a neurosyphilis manifestation, requires careful diagnosis. This case highlights the importance of treponemal tests over non-treponemal tests like VDRL for accurate diagnosis in CNS syphilis.

Keywords:
CSF FTA-ABSCSF VDRLNeurosyphilisOcular syphilisSyphilis

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Neurology

Background:

  • Syphilis is a re-emerging infectious disease with potential ocular and neurological complications.
  • Ocular syphilis can present with diverse symptoms, including visual disturbances and retinal findings.
  • Accurate diagnosis of neurosyphilis is crucial for timely and effective treatment.

Purpose of the Study:

  • To report a case of ocular syphilis presenting as neurosyphilis in an immunocompetent individual.
  • To emphasize the diagnostic utility of specific syphilis tests in cases of suspected central nervous system involvement.
  • To highlight the limitations of non-treponemal cerebrospinal fluid tests in diagnosing ocular syphilis.

Main Methods:

  • A case study of a 47-year-old male with visual symptoms.
  • Ophthalmologic examination including funduscopy and fluorescein angiography.
  • Serological testing including chemiluminescent microparticle immunoassay, Venereal Disease Research Laboratory (VDRL), Treponema pallidum particle agglutination (TP-PA), and immunofluorescence antibody absorbed (FTA-ABS) tests.
  • Cerebrospinal fluid (CSF) analysis including VDRL and FTA-ABS testing, and syphilis PCR.

Main Results:

  • The patient presented with photopsias, floaters, and visual field defects, with funduscopic findings of optic disc swelling, vitritis, and retinal infiltrates.
  • Serum treponemal antibody tests were positive, with a VDRL titre of 1:32.
  • CSF analysis showed reactive FTA-ABS but non-reactive VDRL.
  • The patient was diagnosed with neurosyphilis and successfully treated with intravenous ceftriaxone.

Conclusions:

  • Non-reactive CSF VDRL results should not exclude neurosyphilis diagnosis when serum tests are positive and clinical suspicion is high.
  • Treponemal CSF tests like TP-PA and FTA-ABS demonstrate higher sensitivity for detecting central nervous system and ocular syphilis compared to non-treponemal tests.
  • Early and accurate diagnosis of ocular syphilis is essential for preventing irreversible vision loss.