A vascular syphilitic iris lesion

Area of Science:

• Ophthalmology
• Infectious Diseases
• Medical Imaging

Background:

• Ocular syphilis can present with diverse manifestations, including uveitis.
• Iris papulosa is a rare finding in ocular syphilis, necessitating accurate diagnostic imaging.

Observation:

• A 60-year-old male presented with granulomatous anterior uveitis and a vascularized iris papule.
• Anterior segment optical coherence tomography (AS-OCT) showed a hyperreflective iris lesion with vascular lumens.
• Ultrasound biomicroscopy (UBM) identified an echodense mass with hyperechogenicity.

Findings:

• AS-OCT and UBM provided characteristic imaging signatures for iris papulosa.
• Systemic work-up confirmed syphilis as the underlying cause.
• The patient was treated with topical steroids and parenteral penicillin.

Implications:

• Iris papulosa, visualized via AS-OCT and UBM, is a potential indicator of ocular syphilis.
• This case highlights the importance of considering syphilis in the differential diagnosis of undifferentiated vascular iris masses.
• Advanced imaging techniques are crucial for characterizing rare ocular manifestations of syphilis.