J Korean Ophthalmol Soc.  2014 Apr;55(4):602-607.

Clinical Manifestations of Ocular Syphilis Combined with Neurosyphilis

• Cho YW
• Kim CR
• Han YS
• Chung IY
• Park JM

Abstract

PURPOSE
To report the manifestation of ocular syphilis combined with neurosyphilis in patients who present with uveitis clinically and are diagnosed initially by an ophthalmologist.
METHODS
This study is a retrospective, clinical investigation of seven male patients with ocular syphilis from a single tertiary center between 2009 and 2012.
RESULTS
The average age of the patients at onset was 44.4 years (range, 33-71 years). Posterior segment involvement was found in all patients. Two patients had papillitis. In serologic testing, all patients had positive responses to Venereal Disease Research Laboratory (VDRL), fluorescent treponemal antibody-absorption test (FTA-ABS) and Treponema pallidum hemagglutination (TPHA). In fluorescein angiography (FAG), retinal vascular and disc leakage was the most common finding. Cerebrospinal fluid (CSF) analysis was performed for six patients and demonstrated positive CSF FTA-ABS and CSF TPHA tests in all patients. CSF VDRL was reactive in 2 patients (33.3%).
CONCLUSIONS
All patients with ocular syphilis were diagnosed with neurosyphilis based on the analysis of CSF with FTA-ABS and TPHA. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis.

Keyword

CSF analysis; Neurosyphilis; Ocular syphilis

MeSH Terms

Cerebrospinal Fluid
Early Diagnosis
Fluorescein Angiography
Fluorescent Treponemal Antibody-Absorption Test
Hemagglutination
Humans
Male
Neurosyphilis*
Papilledema
Retinaldehyde
Retrospective Studies
Serologic Tests
Sexually Transmitted Diseases
Syphilis*
Treponema pallidum
Uveitis
Retinaldehyde

Figure

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  Figure 1. Photographs of Patient 2. (A) A right eye fundus photograph, at the first visit, shows normal retinal appearance. (B) A left eye fundus photograph, at the fist visit, shows subfoveal exudation and macular edema. (C) A right eye fluorescein angiograph at the mid-phase shows peirvascular and multiple RPE leakage at the super-otemporal quaderant. (D) A left eye fluorescein angiograph at the mid-phase shows macular pooling of dye and peripheral PRE active leakage. (E) A right eye fundus photograph, at the last visit, shows normal retinal appearance. (F) A left eye fundus photograph, at the last visit, shows subfoveal exudation and macular edema resolved.

Reference

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