Ocular syphilis presenting as panuveitis: a management approach for the non-uveitis specialist

We describe the challenging clinical scenario of an adult male presenting with acute, uniocular, sight-threatening panuveitis to a tertiary eye emergency department. Clinically, this was characterised by painless anterior chamber inflammation and significant vitritis, precluding clear fundal view.We outline the initial approach to establishing an appropriate working diagnosis, the laboratory investigations, multimodal imaging undertaken and empirical treatment administered in the first instance for imminently sight-threatening infectious causes. The principles described may be applied to other cases of panuveitis in an emergency setting, particularly with the non-uveitis specialist in mind. We emphasise the importance of considering the overall systemic health of the patient and possible associated or causative systemic disease. Finally, we include multimodal imaging that demonstrates features of acute syphilitic posterior placoid chorioretinitis and the ocular response to treatment coinciding with visual recovery.