A Case of Acute Interstitial Keratitis in a Patient with Acquired Syphilis

PURPOSE: To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis. CASE SUMMARY: A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epithelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABS IgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient's right eye improved to 20/20. CONCLUSIONS: We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an immunocompetent patient.

Cilindros retrocorneanos: un hallazgo poco usual de la queratitis por sífilis / Retrocorneal cylinders: an unusual fi nding of syphilitic keratitis

Objetivo: Describir el caso de una paciente con una presentación inusual de queratitis intersticial por sífilis. Diseño: Estudio descriptivo, retrospectivo, reporte de caso. Metodología: Se realizó una revisión de la historia clínica del paciente y de la literatura con referencia al diagnóstico. Resultados: Paciente femenina de 67 años quien consulta por cuadro de 4 días de evolución de disminución progresiva y dolorosa de agudeza visual en ojo derecho. En el examen oftalmológico se evidenció una lesión cilíndrica, ramificada en cámara anterior, con adherencias al endotelio corneano, edema y leucoma corneano por lo cual se diagnosticó queratitis intersticial por sífilis; se confirmó por serología y se realizó el manejo correspondiente. Conclusiones: Aunque la queratitis intersticial por sífilis tiene baja incidencia y prevalencia en la actualidad, debe tenerse en cuenta dentro de los diagnósticos diferenciales en pacientes que presenten queratitis estromal no ulcerativa y así mismo, debe hacerse estudio serológico en todos los casos de queratitis estromal bilateral cuya causa no esté definida ya que puede ser la única manifestación de la enfermedad. Un hallazgo clínico raro es la aparición de cilindros, rollos o membranas retrocorneales. El conocimiento de todas las formas de presentación, aún las más infrecuentes, como en nuestro caso es importante en el diagnóstico y manejo de esta patología.

Objective: Describe the case of a patient with an unusual presentation of syphilitic interstitial keratitis. Design: A descriptive, retrospective study and case report. Methodology: A literature review was made about the pathology and specific diagnosis. Results: A 67-year-old female patient was seen for a 4-day course of progressive and painful decrease of visual acuity in the right eye. During the ophthalmologic examination, a cylindrical and branching lesion with adhesions to the corneal endothelium was noted, corneal edema and leukoma was also founded. Diagnosis of interstitial syphilitic keratitis was made; the clinical picture was confi rmed by serology and the patient was managed accordingly. Conclusions: Although syphilitic interstitial keratitis has low incidence and prevalence, this disease must be considered into the differential diagnosis of patients with non-ulcerative stromal keratitis and a serology study must be done in all cases of bilateral stromal keratitis, as it may be the only manifestation of the disease. An unusual finding is the appearance of cylinders, rolls or retrocorneal membranes. Knowledge of all forms of presentation, even the most infrequent, as in this case, is important in the diagnosis and management of this condition.

A Case of Mycobacterium Tuberculosis Keratitis

PURPOSE: Mycobacterium tuberculosis usually affects the lungs, although it may involve various segments of the eye and cause severe visual loss if not treated properly. We report the case of Mycobacterium tuberculosis keratitis treated successfully with antituberculous medication and amniotic membrane transplantation. METHODS: A 48-year-old male patient diagnosed as cervical tuberculous lymphadenitis about 20 years ago was referred from other hospital. He complained about painless corneal opacity on right eye. And other systemic evaluation other than cervical lymphadenitis was not remarkable. On biomicrosopy, peripheral multiple corneal opacity and neovascularization were observed. Fortified tobramycin eyedrops and oral antituberculous medication were used preoperatively. Under local anesthesia, the lesion was removed, and lamellar keratoplasty with lyophilized cornea and amniotic membrane transplantation was performed. Amikacin eyedrops was used postoperatively. RESULTS: From postoperative day 15, corneal opacity was decreased gradually. CONCLUSIONS: Mycobacterium tuberculosis should be considered as one of the causes of keratitis manifesting painless corneal opacity concomitant with cervical tuberculous lymphadenitis. Proper examination and management are necessary.