Bilateral Chorioretinitis as Syphilis Presentation: Multimodal Characterization and Therapy Response

Abstract

A 47-year-old caucasian man presented bilateral and progressive vision decline since two weeks. His medical and family history was unremarkable; he was not taking any medication and he denied other symptoms. He reported a history of multiple sexual partners in the past few years, with inconsistent use of barrier protection.On the ophthalmic examination, his Best-Corrected Visual Acuity (BCVA) was of 20/25 in the right eye and 20/63 in the left eye. The anterior segment, the tonometry and the pupillary reflexes were normal. Screening blood tests were requested and the VDRL (Venereal Disease Research Laboratory) returned reactive, followed by positive treponemal-specific tests (FTA-ABS and TPHA), confirming active infection. The patient was HIV negative and his HIV status remained negative three months following initial presentation. All other infectious and autoimmune screening tests were negative. A lumbar puncture was also performed and the cerebrospinal fluid cell count was 23 white blood cells per microliter with 96% of mononuclear cells, the glucose level was 67 mg/dl and the protein level was 37 mg/dL, VDRL was reactive and TPHA was positive. The cranial computerized tomography performed was normal.Therefore, he was diagnosed with Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC) and neurosyphilis and prompt

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

“…It can affect any organ in the body, including the eyes. Known as the ¨great imitator¨, syphilis has a wide variety of ocular presentations such as anterior uveitis, intermediate uveitis, interstitial keratitis, chorioretinitis, retinal vasculitis, retinitis, perineuritis, papillitis, retrobulbar neuritis, optic atrophy, and optic nerve gumma 1 , 2 . Therefore, it is recommended to test every patient with ocular inflammation for syphilis 1 , 2 …”

“… 1 , 2 Therefore, it is recommended to test every patient with ocular inflammation for syphilis. 1 , 2 …”

A Rare Case of Neurosyphilis with Ocular Involvement in a Patient with HIV Infection and New Onset Syphilis

“…In the current era, HIV-infected patients are more prone to develop NS, with higher risk in patients with CD4 cell counts ⩽350 cells/μL and RPR titer >1:32 [3, 4]. Ocular involvement is very rare in NS and accounts for only 1%-5% of the cases in the United States [5,6].…”

Eyes As the Window to Syphilis: A Rare Case of Ocular Syphilis As the Initial Presentation of Syphilis

“…HIV-infected patients in particular are more prone to develop NS [5]. Ocular involvement is very rare in NS and accounts for only 1%-5% of the cases in the United States [6,7]. We report the case of a patient who presented with a "black spot" in his vision and was found to have ocular syphilis and NS.…”