Bilateral exudative retinal detachment in undiagnosed ocular syphilis after treatment with corticosteroids

Aguilar-González, Marina; Fernández-Santodomingo, A.S.; Marín-Payá, Emma; Rahhal-Ortuño, Miriam; Udaondo, Patricia

doi:10.1177/1120672119889007

Cited by 5 publications

(3 citation statements)

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“…The first reason ocular syphilis is recognized as sight-threating is that it is easily misdiagnosed as a noninfectious eye disease and then erroneously treated with a systemic or local steroid which might cause irreversible visual loss. Deterioration of uveitis or optic neuritis and decreased vision were frequently reported in ocular syphilis patients misdiagnosed as non-infectious ocular inflammations (4,5). In this study, 22 cases were erroneously treated with oral steroid or peribulbar injection before ocular syphilis was diagnosed and all underwent visual deterioration.…”

Section: Discussionmentioning

confidence: 80%

“…Pratas et al reported that 75% of ocular syphilis cases had a good final visual outcome of best-corrected visual acuity (BCVA) ≥20/40 (1). Unfortunately, ocular syphilis may occasionally present as the only clinical manifestation of syphilis, and mimic other ophthalmic diseases such as non-infectious uveitis or optic neuritis, and therefore, can be easily misdiagnosed or erroneously treated with steroids which probably leads to irreversible visual loss (4,5). Gu et al reported that 23.5% of the late syphilis cases they researched met the WHO definition of blindness prior to treatment and patients with optic atrophy before treatment showed permanent visual loss.…”

Section: Introductionmentioning

confidence: 99%

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Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China

Sun

Liu

et al. 2022

Front. Immunol.

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PurposeTo report the demographic, clinical, and laboratory characteristics of ocular syphilis based on a 6-year case series study from an eye center in East-China.MethodsA total of 131 cases (191 eyes) of ocular syphilis and the annual number of total syphilis cases from January 2016 to December 2021, were included in this study. Detailed medical records including systemic and ophthalmic medical history, a complete ophthalmic examination, color fundus photography, B-type ultrasound, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT), laboratory tests of the serum and cerebrospinal fluid (CSF) samples, as well as visual field test and orbital or cranial MRI in cases with suspected optic neuritis or optic atrophy, were collected and analyzed. Pearson Chi-square or Fisher’s exact tests was used for statistics analysis.ResultsOf the 131 cases with ocular syphilis, 86 cases were in men and 6 cases had a past medical history or systemic manifestation of syphilis. HIV was found in only 2 of 70 cases undergoing serum HIV test. The average age was 54.0 years, ranging from 26–85 years. The average percentage of ocular syphilis out from the total syphilis cases was 5.1%, the average titer of serum rapid plasma regain (RPR) at presentation was 1:32, ranging from 1:1–1:512. The most predominant manifestation of ocular syphilis was posterior uveitis, followed by optic neuritis, optic atrophy, panuveitis, retinal vasculitis, and retinitis. The median of BCVA of all 191 eyes was 20/200 (ranging from no light perception to 20/20), and 20/40 (ranging from no light perception to 20/20) at presentation and final follow-up, respectively. Ocular syphilis with active inflammation responded well to penicillin therapy, no matter the initial visual acuity, ocular disease type, or RPR titers, as long as it was diagnosed early and treated properly and promptly. However, cases with optic atrophy, acute retinal necrosis, late diagnosis, permanent disruption, or loss of outer segment of photoreceptors of macular retina on SD-OCT showed poor visual improvement after therapy.ConclusionsEarly diagnosis of ocular syphilis is still challenging in clinical practice and syphilis tests should be routinely performed in patients with uveitis, retinitis, optic neuritis, and optic atrophy.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China

Sun

Liu

et al. 2022

Front. Immunol.

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“…This is likely due to a type II error as our sample size consisted of 18 eyes and may not have been sufficiently powered to detect differences in the timepoint of steroid initiation. It is also worth noting that no patients in our study received steroids prior to the initiation of the penicillin as this could potentially exacerbate the infection and result in poor patient outcomes [13]. The patients in this study were also all immunocompetent with CD4+ counts higher than 500; therefore, more research needs to be conducted to assess the risk and benefits of initiating steroids in patients with low CD4+ counts.…”

Section: Discussionmentioning

confidence: 98%

Assessment of Visual Acuity Outcomes in Ocular Syphilis Treated With Adjunctive Topical or Oral Steroids

Ishihara¹,

Buscho²,

Yu³

et al. 2023

Cureus

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Purpose: There is no consensus surrounding adjunctive steroid use in the treatment of ocular syphilis. We evaluated clinical outcomes of patients with ocular syphilis who were treated with penicillin plus either topical or oral steroids.Methods: Nine male patients aged 26 to 72 years with a diagnosis of ocular syphilis were retrospectively identified (18 eyes). All patients were treated with penicillin and adjunctive topical or oral steroids. Visual acuity reported as the logarithm of the minimum angle of resolution (logMAR) and slit lamp findings were documented at presentation, short-term follow-up (<7 days after initiating therapy), and long-term followup (day 7+). Visual acuity outcomes were compared between eyes treated with topical versus oral steroids as well as eyes treated simultaneously with adjunctive steroids and penicillin versus patients treated with steroids after penicillin.Results: At short-term follow-up, the mean logMAR (SD, Snellen fraction) visual acuity for eyes treated with topical steroids 0.93 (0.53, 20/170) was significantly lower than that for the oral steroid group 0.23 (0.09, 20/110; p=0.0075). Similarly, at long-term follow-up, the topical steroid group had a significantly lower visual acuity of 0.75 (20/112) compared to a visual acuity of 0.07 (20/25) for the oral steroid group (p=0.0022). Moreover, the oral steroid group displayed significant improvement in visual acuity at long-term follow-up compared to baseline while the topical steroid group did not demonstrate the same effect (p=0.0406 and p=0.5945, respectively). Initiation of steroid treatment simultaneously with penicillin did not result in better visual acuity than delayed steroid treatment (p>0.05).Conclusions: Steroids are an effective adjunctive treatment for patients with ocular syphilis. Oral steroids may be superior to topical steroids for improving visual function, especially in patients with a severe inflammatory component. Patients treated with oral or topical steroids and penicillin simultaneously did not demonstrate better visual acuity outcomes than patients treated with oral or topical steroids after penicillin was initiated.

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Methylprednisolone

2021

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Bilateral exudative retinal detachment in undiagnosed ocular syphilis after treatment with corticosteroids

Cited by 5 publications

References 10 publications

Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China

Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China

Assessment of Visual Acuity Outcomes in Ocular Syphilis Treated With Adjunctive Topical or Oral Steroids

Methylprednisolone

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