RESUMEN

This case report presents bilateral anterior uveitis (BAU) in a 26-year-old male concurrently infected with HIV and syphilis, highlighting a rare and complex clinical presentation. BAU, typically linked with systemic diseases, poses significant diagnostic and therapeutic challenges when co-occurring with such infections. Despite common associations with posterior uveitis in co-infected individuals, this patient displayed BAU, underscoring the variability in ocular manifestations. The case details the clinical progression, diagnosis, and management strategies, emphasizing the need for comprehensive ophthalmologic and systemic evaluation. The report aims to enhance awareness and understanding of the implications of concurrent HIV and syphilis infections in ocular inflammation, advocating for tailored treatment approaches and a high index of suspicion in similar presentations.

RESUMEN

Jarisch-Herxheimer reaction (JHR) is a transient clinical phenomenon in patients with syphilis who receive antibiotic treatment. A 31-year-old man with an underlying HIV infection presented with worsening vision in the right eye two days after being treated with oral doxycycline for presumed left-eye neuroretinitis. Prior history revealed two episodes of penile discharge and ulcers that were not investigated. Examination showed bilateral optic disc swelling with right eye placoid chorioretinitis around the macula. Optical coherence tomography (OCT) demonstrated right macular edema and left macular thinning. Blood investigations confirmed syphilis infection. Subsequently, the patient was scheduled for a contrasted brain CT with oral steroid coverage due to underlying allergies. His vision incidentally improved soon after the short course of steroids. Repeated OCT demonstrated marked improvement of right macular edema, which we believe was secondary to JHR initiated by the earlier doxycycline treatment. Following oral steroid addition, improvement in vision and ocular findings were seen. At six-month post-treatment, there was right macular atrophy as a sequela of the macular edema. Ophthalmologists should be aware of ocular-related JHR complications, particularly in potentiating macular atrophy following macular edema upon initiating antibiotic treatment in syphilitic disease.

RESUMEN

Within the specialties of infectious diseases and dermatology, few rashes involve the palms and soles. The syphilitic rash has a pathognomonic association with these body surfaces and signals physicians to investigate this disease. However, the distinct presentations and symptoms associated with syphilis and the various stages of the disease make it diagnostically challenging. We herein report a rather intricate and unusual case of a patient who presented with a new-onset headache and blurred vision and a two-month history of diffuse pruritic maculopapular rash sparing the palms and soles. Several physicians had not established a diagnosis in the outpatient setting. Inpatient workup eventually revealed that the patient was suffering from secondary syphilis with neurological and ocular involvement. Management included a prolonged course of intravenous penicillin G leading to a complete recovery. We share images of the skin findings and the details of the intricate workup and hospital course, as well as a review of the literature.

RESUMEN

BACKGROUND: Syphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns. METHODS: 103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis. RESULTS: Members managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10-14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis. CONCLUSION: This comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.

Asunto(s)

Infecciones Bacterianas del Ojo/diagnóstico , Oftalmología/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Sífilis/diagnóstico , Uveítis/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/organización & administración , Penicilinas/uso terapéutico , Derivación y Consulta , Estudios Retrospectivos , Sociedades Médicas , Encuestas y Cuestionarios , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis , Uveítis/tratamiento farmacológico

RESUMEN

Objective To summarize and describe clinical features and treatment outcome of syphilitic scleritis.Methods A retrospective study was conducted in patients diagnosed as syphilitic scleritis from 2011 to 2016 in our hospital.Clinical characteristics and prognosis were evaluated.Results Seven patients (7 eyes) were diagnosed as syphilitic scleritis by clinical and serological examinations.All patients were unaware that they had syphilis infection before visit.The ocular manifestation was the only clinical fmdings in three patients.Both treponema pallidum particle agglutination and rapid plasma regain were positive.Meanwhile,the scleritis infection was excluded,tests for human immunodeficiency virus (HIV) were negative.Syphilitic scleritis was unilateral in all patients,and the duration was from one week to two years.Initial symptoms were varied in degree of ocular redness,pain and visual impairment.Two patients presented with anterior episcleritis,nodular anterior scleritis was found in three patients,one patient showed diffuse anterior scleritis,and one patient presented with diffuse episcleritis combined with acute syphilitic posterior placoid chorioretinitis.All patients were treated with penicillin G,and inflammation resolved quickly after treatment.Conelusion Syphilitic scleritis is rare and ease to be misdiagnosed,various types of anterior scleritis is the main manifestation.Syphilitic serologic test should be performed for the suspected cases.The prognosis is well with anti-syphilis therapy.