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Choroidal neovascularization secondary to ocular syphilis
Marta Paula Świerczyńska1,2, Lech Stanisław Sedlak1,2, Marta Anna Nowak1,2,3
1Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Romanian Journal of Ophthalmology
|January 28, 2022
Summary
Ocular syphilis can cause choroidal neovascularization (CNV), a rare but serious complication. This case highlights a patient with visual loss due to syphilis-induced neuroretinitis and CNV, emphasizing the need for prompt diagnosis and treatment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neuro-ophthalmology
Background:
- Choroidal neovascularization (CNV) is a rare but severe complication of ocular syphilis.
- Syphilis can manifest with diverse ocular findings, including neuroretinitis.
Observation:
- A 51-year-old woman presented with acute visual loss in her right eye.
- Fundus examination revealed vitritis and optic disc edema; fluorescein angiography showed optic nerve and macular edema with blood-retinal barrier leakage.
- Optical coherence tomography (OCT) demonstrated retinal pigment epithelium (RPE) irregularities, subretinal fluid, and hyperreflective material.
Findings:
- The patient was diagnosed with bilateral neuroretinitis and presented with serological evidence of syphilis.
- She received treatment with ceftriaxone, steroids, and cycloplegics.
- Refusal of lumbar puncture and anti-vascular endothelial growth factor (anti-VEGF) therapy impacted visual prognosis.
Implications:
- This case underscores the importance of considering syphilis in the differential diagnosis of neuroretinitis and CNV.
- Early diagnosis and comprehensive treatment, including consideration for cerebrospinal fluid (CSF) analysis and potential anti-VEGF therapy, are crucial for managing ocular syphilis.
- Ocular syphilis requires a multidisciplinary approach for optimal patient outcomes.
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