Ocular Syphilis: Staring Straight at You

1University of Missouri–Kansas City School of Medicine, Kansas City, MO

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 273

Case Presentation:

A 54‐year‐old heterosexual man presented with a 4‐month history of progressive photophobia of the left eye. He denied any diplopia, pustule discharge, and visual field defects. Four months previously, he was treated with topical and oral steroids for inflammatory keratitis with some relief; however, photophobia was exacerbated with steroid taper. His medical history was pertinent for hypertension and neuropathy treated with lisinopril and gabapentin, respectively, with no known drug allergies. While in the service overseas, he had multiple female partners and engaged in sexual activity without any barrier contraception. He has been in a monogamous relationship with his girlfriend for the past 4 years. Vital signs were: afebrile, blood pressure 140/82, respiratory rate 18, and pulse rate 72. Patient was alert and oriented. Visual acuity of the right eye was 20/20 and of the left eye 20/400. Fundoscopic exam of the left eye showed interior endothelial keratic precipitates. Neurological exam revealed 21 reflexes in all extremities, and CN II–XII were grossly intact. Serological testing for syphilis was negative for rapid plasma reagin (RPR); however, it was positive for fluorescent treponemal antibody absorption (FTA‐ABS) and for Treponema pallidum hemagglutination. Further, lumbar puncture was completed and was positive for RPR and FTA‐MB, confirming our suspicion of neurosyphilis. Serology for HIV, Brucella, and Leptosprira and assays for the detection of fungal antigen in the serum gave negative results. The patient was treated with intravenous penicillin G 24 million units per day for 14 days. At the 2‐ and 4‐month follow‐ups, his visual acuity had improved and uveoscleritis resolved.

Discussion:

A reemergence of syphilis has been reported in the United States and Europe. The case described underlines that the eye may be one of the numerous site of syphilitic inflammation and damage. Secondary syphilis caused progressive deterioration of ocular findings in our patient. This condition may result in permanent loss of vision if not adequately treated.

Conclusions:

Syphilis is known as the great “imitator” or “masquerader” of myriad presenting symptoms. This case presentation highlights the importance of considering the diagnosis of syphilis in the setting of unilateral photophobia. Ocular involvement should be carefully evaluated in patients with syphilis and should be considered as a potential cause of ocular inflammation.

Disclosures:

V. Faridani ‐ none; K. Khosa ‐ none; S. Lutchmedial ‐ none; D. Eliason ‐ none

To cite this abstract:

Faridani V, Khosa K, Lutchmedial S, Eliason D. Ocular Syphilis: Staring Straight at You. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 273. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/ocular-syphilis-staring-straight-at-you/. Accessed December 7, 2019.

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