Ocular syphilis masquerading as refractory retinal diseases

Area of Science:

• Ophthalmology
• Infectious Diseases
• Retinal Diseases

Background:

• Syphilis can present with diverse ocular manifestations.
• Ocular syphilis is often misdiagnosed, particularly when mimicking common chronic macular diseases.
• Refractory cases of neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) warrant consideration of infectious etiologies.

Purpose of the Study:

• To highlight two cases where syphilis mimicked chronic refractory macular diseases.
• To emphasize the importance of considering syphilis in atypical presentations of retinal diseases.
• To underscore the diagnostic utility of systemic evaluations and specific imaging in suspected ocular syphilis.

Main Methods:

• Case report of two patients with refractory macular diseases (neovascular AMD and DME).
• Patients underwent standard treatments including anti-vascular endothelial growth factor (VEGF) injections and surgery without improvement.
• Systemic syphilis evaluation was performed, followed by intravenous penicillin treatment.

Main Results:

• Both patients showed significant improvement in their macular conditions after treatment for syphilis.
• The refractory macular diseases resolved with antimicrobial therapy, indicating syphilis as the underlying cause.
• Indocyanine green angiography was noted as potentially helpful in diagnosing occult syphilis.

Conclusions:

• Ocular syphilis can present as chronic, treatment-resistant macular diseases like DME and neovascular AMD.
• Laboratory testing for syphilis should be considered in cases of refractory retinal diseases, not solely for uveitis.
• Prompt diagnosis and treatment of syphilis are essential for managing these challenging ocular conditions.