Anti-inflammatory corticosteroids significantly impair wound healing. Retinoids partially, but significantly, reverse this effect. Little is known about the mechanism of steroid retardation or retinoid reversal. We hypothesized that corticosteroids lower transforming growth factor-␤ (TGF-␤) and insulinlike growth factor-I (IGF-I) levels and tissue deposition in wounds and that retinoids stimulate corticosteroid-impaired TGF-␤ and IGF-I release and collagen production.

This case demonstrates the importance of considering syphilis as a cause of atypical retinitis in the HIV-positive population.

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The use of Infliximab, a blocker of tumour necrosis factor (TNFalpha) could be an alternative approach to the management of refractory scleritis, but further long-term investigations would be necessary to evaluate their safety and efficacy.

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