J Korean Ophthalmol Soc.  2016 May;57(5):857-861. 10.3341/jkos.2016.57.5.857.

Ocular Syphilis Presenting as both Optic Neuritis and Chorioretinitis in both Eyes

• Kim WJ
• Ahn JH
• Kim MM

• KMID: 2212733
• DOI: http://doi.org/10.3341/jkos.2016.57.5.857

Abstract

PURPOSE
To report a patient with ocular syphilis, who showed variable ocular manifestations, including optic neuritis and chorioretinitis in both eyes over a short time period.
CASE SUMMARY
A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. The fundus of the left eye showed a slightly hyperemic optic disc and multiple yellowish deposits. One week later, visual acuity and fundus lesion improved to 20/20 without a definitive treatment. However, 1 month later, he reported a new deterioration of vision in his right eye to 20/40. The right eye had a relative afferent pupillary defect and the fundus examination showed a blurred optic disc margin. Serological work-up was recommended but the patient refused. He returned 3 weeks later with an improvement in the right eye vision (20/25) and a worsening in the left eye (20/200). The examination revealed an improvement of the previously blurred disc margin in the right eye and newly developed chorioretinitis with vasculitis in the left eye. A serological test was performed. The venereal diseases research laboratory titer was 1:32. The fluorescent treponemal antigen absorbance test as positive for IgG and IgM. He was diagnosed with ocular syphilis and referred to the infectious disease department. He was treated with antibiotics. Six months later, the visual acuity was 20/20 in both eyes and the previous fundus lesions had disappeared.
CONCLUSIONS
Ocular syphilis should be considered in patients with atypical and variable clinical course.

Keyword

Chorioretinitis; Ocular syphilis; Optic neuritis

MeSH Terms

Anti-Bacterial Agents
Chorioretinitis*
Communicable Diseases
Humans
Immunoglobulin G
Immunoglobulin M
Optic Neuritis*
Pupil Disorders
Scotoma
Serologic Tests
Sexually Transmitted Diseases
Syphilis*
Vasculitis
Visual Acuity
Anti-Bacterial Agents
Immunoglobulin G
Immunoglobulin M

Figure

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  Figure 1. Ocular findings at the initial visit. (A, B) The fundus photographs at initial visit. (B) The left eye shows a slightly hypere- mic optic disc with multiple yellowish deposits. (C) The visual field test reveals the central scotoma in the left eye. (D) Spectral-domain optical coherence tomography shows a diffuse disruption of the photoreceptor inner segment-outer segment junction line in the macula of the left eye.

• 

  Figure 2. The fundus photography of both eyes when the patient reported a new deterioration of vision in the right eye. (A, B) The fundus photography of the right eye shows a blurred optic disc margin.

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  Figure 3. The ocular findings when the patient reported a worsening of vision in the left eye. (A, B) The fundus photography of the left eye shows chorioretinitis with vasculitis. (C) The fluorescein angiography shows leakage from lesions and retinal vessels.

Reference

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