A Case of Vitritis as the Primary Manifestation without Retinitis in Ocular Syphilis with AIDS

ABSTRACT

PURPOSE: We report a patient of ocular syphilis with acquired immune deficiency syndrome(AIDS) who showed dense vitritis as the primary manifestation without signs of retinitis, and who underwent pars plana vitrectomy. METHODS: A 65-year-old man known to have AIDS complaining of decreased vision in both eyes, was transferred for suspected CMV retinitis. Visual acuity was 0.2 in the right eye and 0.4 in the left eye. Ganciclovir was prescribed intravenously for 10 days and orally thereafter. After 2 months, the visual acuity of both eyes decreased to hand motion. As additional serologic tests such as TPHA and FTA-ABS were positive for syphilis, 5 MU of penicillin G was injected intravenously four times a day for 3 weeks. RESULTS: Although active inflammation decreased with the antibiotic treatment, vitreous opacity persisted. Visual acuity was counting fingers in the right eye and 0.02 in the left eye. Pars plana vitrectomy was performed on the right eye. Analysis of the aspirated vitreous disclosed a VDRL titer of 18, and that TPHA was positive while PCR for CMV was negative. One month after the operation, the patient's visual acuity had improved to 0.6. CONCLUSIONS: Ocular syphilis should be considered in AIDS patient showing dense vitritis as primary manifestation. Pars plana vitrectomy may be an option for early visual restoration of these patients.