Nonhuman Immunodeficiency Virus Ocular Syphilis in Immunocompetent Patients: A Case Series from the Nonsyphilitic Era

To report 5 cases of nonhuman immunodeficiency virus (non-HIV) ocular syphilis in immunocompetent patients in this era.

Retrospective analysis of five cases of retinochoroiditis was done using hospital records over 5 years. Patients were tested for venereal disease research laboratory, HIV and confirmed by treponemal pallidum hemagglutinin assay/fluorescent treponemal antibody absorption. Fundoscopy, fundus fluorescein angiography, and B-scan were done when needed. Appropriate treatment with benzathine penicillin and systemic steroids was instituted in each patient.

First case had panuveitis; second presented with angle-closure glaucoma and neuroretinitis; third case showed recurrent uveitis; fourth one had occlusive vasculitis and retinal detachment, and last case had anterior uveitis with chorioretinal lesions and epiretinal membrane. Marked improvement of vision was seen in four cases, barring one case with retinal detachment.

Non-HIV syphilis-related retinochoroiditis is a masquerader that requires a high index of suspicion, even in immunocompetent individuals. This case series highlights the necessity of including syphilis testing in the workup of atypical uveitis cases, irrespective of systemic manifestations. Furthermore, increased public health awareness and education are critical to address the resurgence of syphilis and prevent its ocular complications.