Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

Abstract

AIM: To report the clinical characteristics, treatment and outcomes of active syphilitic uveitis in human immunodeficiency virus (HIV) positive patients and compare them with the previously published data. METHODS: Retrospective analysis of the case series from an infectious disease center in southern China was conducted. Comprehensive review of previously published cases of HIV positive syphilitic uveitis was conducted using the PubMed and Web of Science databases and the references listed in the identified articles. RESULTS: Twelve HIV positive patients with active syphilitic uveitis were collected. All were male, with age of 36.3y (range 27 to 53y). Five (41.7%) had a history of syphilis, and three of them had received anti-syphilis treatment. Ocular manifestations included corneal epithelial defect (13%), complicated cataract (17.4%), vitreous opacity (82.6%), optic disc edema (26.1%), macular edema (30.4%), neuro-retinitis (43.5%), and retinal hemorrhage (26.1%). After standardized syphilitic treatment, intraocular inflammation was reduced and vision improved in all cases. The literature review summarizes 105 previously reported cases of HIV positive syphilitic uveitis. High serum rapid plasma regain (RPR) titers may be associated with severe uveitis and poor vision. Treatment with penicillin, ceftriaxone sodium, or penicillin plus benzylpenicillin instead of using benzylpenicillin alone can significantly improve best-corrected visual acuity (BCVA) in HIV positive ocular syphilis patients. CONCLUSION: For HIV positive syphilitic uveitis patients, prompt diagnosis and appropriate treatment and follow-up are paramount. In our series, the clinical manifestations are diverse. Syphilis patients treated by penicillin G or long-acting penicillin before may still develop syphilitic uveitis. Patients who relapse after long-term penicillin treatment can still benefit from penicillin G.

Treatment of uveitis and scleritis patients in Malaysia

“…It is noteworthy that contrary to other published studies, aetiologies such as Birdshot chorioretinopathy, onchocerciasis, toxocariasis, Lyme disease, and presumed ocular histoplasmosis syndrome (POHS) were not seen in our population. It is well-known that the aetiology for uveitis varied depending upon epidemiology, geographical, climate variation, and disease dissemination, hence some diseases are not frequently encountered in our part of the world [13][14][15][16][17][18][19][20][21][22][23][24][25] . Herpetic iridocyclitis was the commonest infectious aetiology in our study, similar to Singapore [30] , Thailand [29] , Taiwan China [7] , Japan [32] , and Italy [18] .…”

“…Early diagnosis and timely treatment of uveitis and scleritis are imperative to reduce the risk of visual impairment [8,13] . Epidemiology of ocular inflammation is considerably diverse worldwide and various factors influence it which include host, environmental, genetic, ethnic, socioeconomic, and demographic factors [1][2]6,8,[10][11][13][14][15][16][17][18][19][20][21][22][23][24][25] . A better understanding of the demographic and causes of uveitis and scleritis in various geographic areas will prevent unnecessary laboratory testing, and the delay in commencing treatment [4] .…”