Ocular syphilis masquerading as bilateral peripheral ulcerative keratitis

Abstract

Ocular syphilis has varied manifestations in the eye. Peripheral ulcerative keratitis (PUK) is a crescent-shaped ulcer involving the peripheral cornea and associated with thinning. PUK is caused by both autoimmune and infectious diseases, such as rheumatoid arthritis, tuberculosis, and herpes. Here, we report a rare case of bilateral PUK caused by syphilis. A 55-year-old man presented with recurrent pain and redness in both eyes for 2 months. The cornea of both eyes had bilateral peripheral crescent-shaped ulcers suggestive of PUK. The patient was started on topical steroids elsewhere, but the lesion was not showing any signs of healing. A series of investigations were performed, with positive venereal disease research laboratory and fluorescent treponemal antibody absorption tests. The patient was then started on systemic penicillin, as well as topical steroids. The response to the treatment was good and the ulcer began to heal. PUK as the presenting feature of acquired syphilis is a rare scenario. Such infective causes should be managed with systemic antimicrobials for optimal outcomes.

Severe Cocaine-Induced Midline Destructive Lesions (CIMDL) Leading to Orbital Apex Syndrome and Peripheral Ulcerative Keratitis

“…18,19 In this way, ANCA formation with stimulation of cytokines and collagenases release can contribute to keratolysis. 20,21 Furthermore, hypersensitivity reaction against exogenous triggers, like bacterial antigens, could also have an influence on corneal stromal inflammation, 16,22,23 which would be consistent with the concomitant bacterial infection presented by our patient. Interestingly, it is increasingly recognized that cocaine and levamisole, a common adulterant of cocaine, have been implicated as triggering factors of ANCA development with multiorgan involvement.…”

Perforating Peripheral Ulcerative Keratitis in Syphilis

“…Rare cases with corneal involvement have included stromal keratitis without ulcerations. However, Vignesh et al [2] described a rare presentation of ocular syphilis as bilateral PUK in a patient in India whose bloodwork was positive for Venereal Disease Research Laboratory test (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS). The patient's PUK improved with intravenous penicillin and topical steroids.…”

Peripheral ulcerative keratitis due to systemic diseases

“…Granulomatosis with polyangiitis [45,55] Polyarteritis nodosa [56] Microscopic polyangiitis [57] Eosinophilic granulomatosis with polyangiitis [58] Sarcoidosis [59--61] Behcet's disease [62] Takayasu arteritis Temporal arteritis [63,64] Leukocytoclastic vasculitis [65,66] Cryoglobulinemia [67] IgA vasculitis [57] Atypical HUS [68] Erythema elevatum diutinum [66,69] Systemic infections Herpes simplex virus (HSV) [70--72] Varicella zoster virus (VZV) [73,74] Tuberculosis (Tb) [75,76] Syphilis [77] Bartonella [78] Salmonella gastroenteritis [79] Acquired immune deficiency syndrome [ Hidradenitis suppurativa [93,94] Pityriasis rubra pilaris [95] Drug Induced Checkpoint inhibitors [96--98] Paraquat [99] Rituximab [100] Postvaccine [101] Perifosine [102] Immune reconstitution following antiretrovirals [103] Methamphetamine [104] Other autoimmune Antimyelin oligodendrocyte protein [105,106] IgG4 disease [107] Autoimmune hepatitis [108] Systemic onset juvenile idiopathic arthritis (JIA) [109] Chronic granulomatous disease [110] Local Insults: Microbial keratitis, including bacterial, fungal, viral, mycobacterial, and acanthamoeba Staphylococcal marginal keratitis Postsurgical…”