A case of syphilitic uveitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Immunology

Background:

• Anterior uveitis can be challenging to manage, sometimes progressing despite aggressive corticosteroid therapy.
• Acquired syphilis is a potential, often overlooked, cause of refractory uveitis and panuveitis.
• Neuroretinitis and secondary optic nerve atrophy are severe complications that can arise from untreated syphilitic uveitis.

Observation:

• A 38-year-old male presented with anterior uveitis refractory to escalating topical and systemic corticosteroid and mydriatic treatments.
• The patient's condition advanced to panuveitis and neuroretinitis, indicating severe intraocular inflammation.
• Despite the disease progression, the patient experienced a complete cure following treatment with penicillin injections for acquired syphilis.

Findings:

• Penicillin therapy effectively resolved severe uveitis, panuveitis, and neuroretinitis caused by acquired syphilis.
• The patient developed secondary optic nerve atrophy, highlighting the potential for permanent visual impairment even with successful treatment.
• This case underscores the critical need for considering syphilis in the differential diagnosis of recalcitrant uveitis.

Implications:

• Ophthalmologists must maintain a high index of suspicion for syphilis in patients with uveitis, particularly those unresponsive to conventional therapies.
• Routine serologic testing for syphilis is recommended for patients presenting with unexplained or treatment-resistant uveitis.
• Increased incidence of syphilis necessitates prompt recognition and treatment to prevent devastating ocular and neurological sequelae.