Retinitis syphilitica in an HIV-positive patient following acute retinal necrosis syndrome

Ocular perineuritis secondary to neurosyphilis

BACKGROUND

Syphilis is a condition caused by the spirochete Treponema pallidum (T. pallidum). Because of its ubiquitous nature, it has been coined as "the great masquerader." Syphilis can present with a wide array of clinical symptoms and manifestations, making it difficult to diagnose. The spectrum of visual system manifestations is broad and involves the anterior and posterior segments. We report a rare case of ocular perineuritis in an HIV-positive patient with neurosyphilis.

CASE REPORT

A 33-year-old HIV-positive white male presented with blurred vision and floaters of 2 weeks duration. He reported coinciding neurological symptoms including headaches, nausea, and extreme weight loss. He also manifested an erythematous rash on his scalp. Fundoscopy revealed bilateral disc edema.

CONCLUSIONS

Syphilitic ocular perineuritis is a condition that manifests with swollen optic discs in the absence of raised intracranial pressure or visual disturbance. This condition is due to inflammation of the optic nerve sheath and is often mistaken for papilledema or papillitis. Optic perineuritis is an infrequently reported complication of syphilitic disease. Early diagnosis of neurosyphilis and its complications is critical, because it is easily treated with penicillin when initiated early on.

Update on ocular syphilis

PURPOSE OF REVIEW

The present review updates the reader on publications from the past 5 years relevant to ocular syphilis.

RECENT FINDINGS

Articles from this period are easily grouped into three categories: descriptions of syphilitic ocular manifestations, ocular syphilis in the setting of HIV infection, and treatment of syphilitic ocular disease. While all of the entities described were previously recognized, many are unusual and their description in connection with syphilis is a reminder to be vigilant for this uncommon but everpresent disease. Ocular syphilis can be more severe in patients with HIV infection who are not taking highly active antiretroviral therapy, while with this treatment syphilis is an increasingly likely cause of ocular inflammation. Ocular syphilis should be treated like neurosyphilis, with daily intravenous or intramuscular penicillin for 2 weeks. The prevalence of syphilis has increased markedly in the past 5 years, most notably among men who have sex with men. The fluorescent treponemal antibody assay and similar tests remain the appropriate diagnostic tests for syphilis in patients with ocular inflammation.

SUMMARY

Syphilis lingers on the differential diagnosis of all forms of ocular inflammation and should be considered when evaluating such patients.

Endothelins in chronic diabetic complications

Endothelins are widely distributed in the body and perform several vascular and nonvascular functions. Experimental data indicate abnormalities of the endothelin system in several organs affected in chronic diabetic complications. In support of this notion, it has been shown that endothelin-receptor antagonists prevent structural and functional abnormalities in target organs of diabetic complications in animal models. Alterations of plasma endothelin levels have also been demonstrated in human diabetes. This review discusses the role of endothelins in the pathogenesis of chronic diabetic complications. The current experimental evidence suggests that endothelin-receptor antagonism may potentially be an adjuvant therapeutic tool in the treatment of chronic diabetic complications.