A Unique Case of Syphilitic Hypopyon Panophthalmitis

This work reports a unique case of syphilitic hypopyon panophthalmitis.

A case report is presented.

A 25-year-old man with a history of HIV and intravenous (IV) drug use presented to an outside hospital with blurred vision and swelling of the right eye. Computed tomography was concerning for orbital cellulitis. On examination, he had limited extraocular motility, relative exophthalmos, periocular edema, 4+ anterior chamber cell, an irregular layering hypopyon, and no view of the fundus. Magnetic resonance imaging showed enhancement of the sclera, lateral rectus muscle, and lacrimal gland concerning for infectious or inflammatory panophthalmitis. The patient's history and presentation were concerning for bacterial or fungal etiologies from an endogenous source. He began antimicrobial therapy. Diagnostic vitrectomy was unrevealing. Syphilis testing was positive. The patient showed improvement with IV antiluetic therapy.

We present a case of syphilitic hypopyon panophthalmitis, a new constellation of findings in syphilitic ocular disease.