Title : A rare case of ocular syphilis: Bilateral chorioretinitis and the importance of early diagnosis and treatment
Abstract:
Ocular syphilis is a rare but significant manifestation of syphilis that can occur at any stage of the disease, often presenting with diverse clinical features such as uveitis, optic neuropathy, or retinal vasculitis, and in severe cases, may lead to permanent blindness. The incidence of syphilis has risen steadily in the United States, increasing by 6.8% between 2019 and 2020, with ocular syphilis estimated to occur in 0.65% of syphilis cases, according to a CDC report. It can occur as an isolated ocular condition or alongside neurologic symptoms and is often challenging to diagnose due to its ability to mimic other inflammatory eye diseases and lack of systemic signs in some cases.
However, advances in diagnostic strategies, including serologic testing, have improved detection. Early recognition and prompt treatment with penicillin are essential to prevent permanent visual impairment and reduce the risk of systemic complications. Here we present an interesting case of a 54-year-old female with a past medical history of sexually-transmitted diseases who was found to have ocular syphilis after an ophthalmologist found panuveitis in both eyes on a recent eye exam.
She first noticed arthralgias a year ago, but dismissed these symptoms as age-related. Her vision began to become blurry episodically and she developed floaters in her visual fields. Over time the frequency increased and she began to have visual flares as well. At this point, she went to the optometrist who recommended her to an ophthalmologist. After an eye exam, fluorescein angiography, and optical coherence tomography, it was determined she had panuveitis. An exhaustive workup for panuveitis began and the patient was prescribed steroids in the meantime. Lab work was largely negative except a quantitative RPR returning reactive at 1:128 and reactive Treponema pallidum antibodies. The ophthalmologist discontinued steroids and discussed with the patient to go to the hospital.
In the hospital, a thorough history and physical was performed and she only complained of arthralgias and blurry vision. She denied any rash, fever, sore throat, enlarged lymph nodes, weakness, fatigue, weight loss. Her neurological exam was within normal limits. She explained that she had previously been diagnosed with chlamydia and gonorrhea nine months ago with appropriate treatment. She stated she hadn’t been sexually active since, however, previously had roughly 5 male partners. An infectious disease specialist was consulted and it was determined that she would need 4 million units of IV Penicillin G every 4 hours for 14 days. She stayed in the hospital for 2 days and reported some improvement in her symptoms before she was discharged home with home health for antibiotics.
