A Case of Syphilis with a Rare Finding: Subretinal Hypopyon

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neuro-ophthalmology

Background:

• Optic neuritis requires careful etiological investigation, especially for infectious causes.
• Syphilis is a potential cause of optic neuritis and intraocular inflammation.

Observation:

• A patient presented with optic neuritis and was treated with intravenous pulse steroids without antibiotics.
• Subretinal hypopyon and retinitis foci developed during follow-up, alongside a positive TPHA test.
• The patient was referred to a uvea clinic due to decreased vision.

Findings:

• Subretinal hypopyon and retinitis significantly regressed following antibiotic therapy.
• Initial steroid treatment without antibiotics appeared to exacerbate the clinical features of ocular syphilis.

Implications:

• Infective etiologies, particularly syphilis, must be considered before initiating steroid treatment for optic neuritis.
• Inadequate antibiotic treatment in syphilitic optic neuritis can lead to poor clinical outcomes.
• This case underscores the importance of a comprehensive diagnostic workup and appropriate antimicrobial therapy in managing neurosyphilis.