ABSTRACT
ABSTRACT Syphilis is a reemerging and potentially serious disease. Owing to its ubiquity and pleomorphism, it is called "the great imitator". We report the case of a young woman with secondary syphilis who presented with bilateral acute syphilitic posterior placoid chorioretinopathy along with a syphilitic skull periostitis. A pachymeningeal enhancement was observed on magnetic resonance imaging, but we believe it was an extension of the bone process rather than a meningitis itself on the basis of the normal cerebrospinal fluid analysis results. Treatment with intravenous crystalline penicillin resulted in complete resolution of the signs, symptoms, and imaging findings. Secondary syphilis is the stage with the highest bacteremia and the highest transmissibility, presenting mainly with mucocutaneous disorders and, less frequently, with involvement of other organs. High suspicion and a pragmatic approach are essential to the diagnosis because this disease can affect several organs, as in the present case, in which the eyes, bones, and skin were affected.
RESUMO A sífilis é uma doença reemergente e potencialmente grave. Por sua onipresença e pleomorfismo, é denominada "grande imitadora". Relatamos caso de paciente jovem com sífilis secundária, que se apresentou com coriorretinopatia placóide sifilítica posterior aguda bilateral, simultaneamente a periostite craniana sifilítica. A despeito de realce paquimeníngeo observado na ressonância magnética, acreditamos que este tenha sido uma extensão do processo ósseo e não, uma meningite em si, uma vez que o exame do líquido cefalorraquidiano estava completamente normal. Tratamento com penicilina cristalina intravenosa resultou em completa resolução dos sinais, sintomas e achados de imagem. A sífilis secundária é o estágio de maior bacteremia e maior transmissibilidade da doença, apresentando-se principalmente com quadros mucocutâneos, mas também, menos frequentemente, com envolvimento de outros órgãos. Elevada suspeição e uma abordagem pragmática são necessárias para o diagnóstico, uma vez que essa doença pode afetar vários órgãos, como no caso relatado, em que foram acometidos olhos, ossos e pele.
ABSTRACT
Acquired syphilis uveitis,due to lack of the characteristic features,presents with various types.The most common type is posterior uveitis and panuveitis,including chorioretinitis,retinal vasculitis,optic nerve retinitis.The diagnosis and assessment of response to treatment depends mainly on the serological diagnostic tests,including nontreponemal and treponemal test.Acquired syphilis uveitis often presents with manifestations similar to various types of uveitis,especially to autoimmune uveitis and other infectious uveitis,so differential diagnosis is important.The gold standard treatment for active syphilitic uveitis is penicillin G,or doxycycline if patient is allergy to penicillin.Clinically misdiagnosis and delayed treatment may result in irreversible visual impairment and severe systemic and eye complications.However such timely treatment always has a good prognosis.
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Objective To observe the fundus imaging characteristics of different stages of syphilitic posterior uveitis. Methods Retrospective cases series. Forty-six eyes of 32 patients with syphilitic posterior uveitis were included. There were 14 patients (16 eyes) and 18 patients (30 eyes) were assigned to acute stage group (with the course<2 months) and chronic stage group (with the course≥2 months) respectively. All eyes received the examination of indirect ophthalmoscopy, color fundus photography, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). All patients received regular anti-syphilitic treatment. Color fundus photography and OCT were followed after treatment. The fundus imaging characteristics of different stages of syphilitic posterior uveitis were observed. Results Indirect ophthalmoscopy and fundus color photography showed that in the acute stage group, there were 3/16 eyes with optic disc edema;4/16 eyes with a yellowish, placoid lesion involving the macular. There were only some pigment alterations on the fundus after treatment. In the chronic stage group, there were 4/30 eyes with optic disc hyperemia, 3/30 eyes with cystoid macular edema. After treatment, the optic hyperemia vanished gradually, but there were still some pigment alterations. The FFA images of two groups showed various vascular leakages. In the chronic stage group, patients also showed hyper-fluorescence with cystoid macular edema. The patients with course 2–3 years have more transmitted fluorescence on FFA. OCT showed that all eyes in the acute stage group had lost the ellipsoid zone, with irregular granular reflectivity of the retinal pigment epithelium (RPE) layer, 6 eyes with subretinal fluid in the macular. After treatment, the ellipsoid zone and RPE layer structure recovered gradually. In the chronic stage group, all eyes showed widespread loss of the ellipsoid zone, pigment migration and (or) cystoid macular edema. After treatment, the ellipsoid zone showed partial recovery. The outer ellipsoid zone was still discontinuous in patients with long duration. Conclusions Syphilitic posterior uveitis patients generally had normal fundus, but some cases had a yellowish, placoid lesion involving the macular. FFA showed various vascular leakages, and the chronic stage group showed more transmitted fluorescence. The major OCT change was loss of the ellipsoid zone or with subretinal fluid. After treatment, fundus showed no abnormal manifestations except some pigment alterations;the ellipsoid zone structure recovered gradually in acute stage eyes, partially recovered in chronic stage eyes.
ABSTRACT
Objective To evaluate the clinical features and treatment outcomes of ocular posteriorsegment syphilis.Methods The clinical data of 24 patients with active ocular syphilis wereretrospectively reviewed.The diagnosis was made first in eye clinic,and verified by treponema pallidumparticle agglutination(TPPA)and rapid plasma reagin(RPR).The patients,17 males and 7 females,aged from 30 to 63 years with an average of 47.6 years.The duration of symptoms ranged from 3 days to2 years with an average of 5.8 months(≤1 month,7 cases;1-3 month,5 cases;3-6 months,5 cases;>6 months,7 cases).There were 18 bilateral cases and 6 unilateral cases.The result of humanimmunodeficiency virus(HIV)test was negative for all cases.Twenty-three patients received systemicpenicillin therapy and 1 patient was treated with oral erythromycin due to penicillin allergy.Beforetreatment,the mean visual acuity was 0.17±0.1 9,the mean titer of RPR was 1:84.The follow-up periodwas half a year.Results The major ocular manifestations included bilateral(16 cases)or unilateral(1case)chorioretinitis,unilateral retinal vasculitis(2 cases),unilateral neuroretinitis(2 cases),andbilateral(2 cases)or unilateral(1 case)optic neuritis.The mean follow-up visual acuity was 0.60±0.29,the mean follow-up titer of RPR was 1:18.8.Some patients had got the diagnosis and prompt treatment atthe early stage of the disease and their visual acuity recoveried very well.Conclusions The majormanifestion of ocular posterior segment syphilis is chorioretinitis.It is important tO consider the possibilityof syphilis when patients have inflammation of posterior segment.Prompt serology examination andpenicillin treatment are the keys to cure ocular syphilis.