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

Paulraj, Shweta; Kumar, Prashanth Ashok; Gambhir, Harvir Singh

doi:10.7759/cureus.6998

Cited by 4 publications

(9 citation statements)

References 17 publications

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“…Ocular syphilis can occur at any time during the course of syphilis but usually accompanies early neurosyphilis with acute meningitis [ 8 ]. The predictor for neurosyphilis is an RPR titre >1:32 [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Ocular Syphilis Mimicking Giant Cell Arteritis

Qadir¹,

Khakwani²,

Khan³

et al. 2022

Cureus

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Syphilis is a rare cause of vision loss that mostly occurs after an infection of the meninges, brain tissue, and parenchyma. Syphilis can mimic auto-immune disease like giant cell arteritis which also manifest as sudden vision loss. Spirochete Treponema pallidum can spread through sexual contact and cause painless ulcers. Spirochetes can disseminate systemically and lead to secondary syphilis. Ocular syphilis can affect all parts of the eye in secondary and tertiary stages. It can present as scleritis, inflammation of the optic nerve, and uveitis. We present the case of a 59- year-old male suffering from severe vision loss in the left eye and headache initially misdiagnosed with giant cell arteritis. He was correctly diagnosed with ocular syphilis after seeing a red macular rash on palms and soles, and was given penicillin G and probenecid. His visual acuity and field of vision improved soon. Ocular syphilis is usually diagnosed late or misdiagnosed and leads to irreversible vision loss. Physicians should keep in mind the possibility of ocular syphilis in patients presenting with a sudden loss of vision and severe headaches.

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Section: Discussionmentioning

confidence: 99%

Ocular Syphilis Mimicking Giant Cell Arteritis

Qadir¹,

Khakwani²,

Khan³

et al. 2022

Cureus

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“…5 Ocular syphilis can occur at any time during the course of syphilis but often presents in early neurosyphilis with acute meningitis. 13 Nevertheless, ocular syphilis has many manifestations and is classically seen in secondary and tertiary syphilis stages. The most common manifestations of ocular syphilis are panuveitis or posterior uveitis, interstitial keratitis, chorioretinitis, neuroretinitis, retinal vasculitis, and other neuropathies.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] The treatment for ocular syphilis is aqueous crystalline penicillin G, 18 to 24 million units per day administered as 3 to 4 million units IV every 4 hours (or 24 million units daily as a continuous infusion for 10-14 days). 13 Regardless of CSF analysis results, ocular syphilis should be treated per the recommendations for neurosyphilis. In treated patients who still have CSF abnormality, recommended treatment is to follow up with neurological examination including lumbar puncture for CSF-VDRL analysis 3 months after treatment and then every 6 months afterward until the CSF is nonreactive for VDRL and shows normal white blood cell count.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, RPR titers should be monitored every 6 months until there is a 4-fold decline in the titer. Most but not all patients may undergo seroconversion 13 …”

Section: Discussionmentioning

confidence: 99%

“…The treatment for ocular syphilis is aqueous crystalline penicillin G, 18 to 24 million units per day administered as 3 to 4 million units IV every 4 hours (or 24 million units daily as a continuous infusion for 10–14 days) 13 . Regardless of CSF analysis results, ocular syphilis should be treated per the recommendations for neurosyphilis.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Acute Retinal Necrosis From Ocular Syphilis in a Nonimmunocompromised Patient

Jumah¹,

Nair³

et al. 2021

Infect Dis Clin Pract

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Acute retinal necrosis (ARN) is an inflammatory condition of the eye usually caused by viral infection, predominantly herpes simplex virus or varicella-zoster virus. More rarely, noninfectious conditions or infection with other viral and nonviral pathogens can lead to ARN. Onset of disease, which may occur unilaterally or bilaterally, is usually rapid and characterized by a range of symptoms, including pain of eye movement, eye redness, light sensitivity, impaired vision, and narrowing of the visual field. While infectious ARN may develop in otherwise healthy individuals, those who are immunocompromised may be more susceptible to this eye pathology, especially patients who are infected with HIV. Left untreated, ARN can lead to permanent vision loss; thus, rapid identification of the specific etiology of ARN is crucial for implementing appropriate therapies. However, infection with rare pathogens in patients who are at risk for common causes of ARN can complicate diagnosis and treatment, highlighting the need for physicians to know the full range of possible etiologies for the differential diagnosis. We present a case of bilateral ARN in an immunocompetent woman who was infected with genital herpes simplex virus 2, and therefore at high risk of viral infection, but whose ARN was an example of ocular syphilis caused by the bacterial pathogen Treponema pallidum. A review of the literature on ocular syphilis is also discussed.

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Through the Eyes: A Case of Ocular Syphilis

Nwaobi,

Ugoh,

Iheme

et al. 2023

Cureus

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Syphilis is a bacterial disease caused by Treponema pallidum and is sexually transmitted via vaginal, anogenital, or orogenital contact. Vertical transmission between mother and unborn child is also possible, but transmission via skin-to-skin or blood contact is rare. The objective of this case is to highlight this rare ocular manifestation of syphilis as it manifests as a multisystemic disease affecting many organ systems. This is a case of a 46-year-old male with vision loss who was referred to the emergency department by an ophthalmologist. Two days before the presentation at the emergency department, the ophthalmologist observed the presence of optic disc edema in the left eye. At the emergency department, he complained of bright light spots in the left eye and complete darkness in the central aspect of the eyes. He reported having a non-pruritic erythematous rash on the anterior abdomen that began one week before his presentation at the emergency department. The patient also reported having multiple sexual partners. Physical examination findings showed a visual field defect in the left eye, normal bilateral eye movement, and a non-tender skin reticulation over the anterior abdominal wall. Lab results showed complete blood count (CBC) and comprehensive metabolic panel (CMP) within normal limits, fluorescent treponemal antibody (FTA) antibody reactive, human immunodeficiency virus (HIV) test and hepatitis panel negative, rapid plasma reagin (RPR) titer 1:64, and imaging results negative for any significant abnormalities. The infectious disease specialists were consulted, and the recommended IV penicillin of four million units every four hours was given. The patient reported an improvement in his blurry vision over three days. By six months, his vision was back to baseline. This case report is significant due to the rare occurrence of ocular complications as an initial presentation of syphilis. Considering the rising cases of syphilis in the United States, it is important to highlight the possibility of this uncommon clinical presentation of syphilis.

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

Cited by 4 publications

References 17 publications

Ocular Syphilis Mimicking Giant Cell Arteritis

Ocular Syphilis Mimicking Giant Cell Arteritis

Bilateral Acute Retinal Necrosis From Ocular Syphilis in a Nonimmunocompromised Patient

Through the Eyes: A Case of Ocular Syphilis

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