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Reid GA, Halmagyi GM, Whyte C, McCluskey PJ. Ocular vs neurosyphilis. are they the same? A guide to investigation and management. Eye (Lond) 2024; 38:2337-2349. [PMID: 38914721 PMCID: PMC11306553 DOI: 10.1038/s41433-024-03150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/26/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
This article reviews key concepts in the epidemiology, clinical features, diagnosis and management of ocular syphilis. It is not a systematic review or meta-analysis, but highlights the critical clinical features and investigations in patients with ocular syphilis. It reviews the overlap and interplay between ocular and neuro syphilis and provides practical guidance to diagnose and manage patients with ocular syphilis.
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Affiliation(s)
- Gerard A Reid
- Ophthalmology Department, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
- Save Sight Institute, University of Sydney, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Gabor Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, University of Sydney, Specialty of Neurology, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Claudia Whyte
- Department of Infectious Diseases Prince of Wales Hospital, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
| | - Peter J McCluskey
- Save Sight Institute, University of Sydney, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Kawamoto S, Hiyama T, Sada I, Harada Y. Syphilitic Uveitis With Diverse Clinical Presentations: Multimodal Imaging as a Useful Adjunctive Tool for Diagnosis and Treatment. Cureus 2024; 16:e59791. [PMID: 38846191 PMCID: PMC11154847 DOI: 10.7759/cureus.59791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
We report four cases of syphilitic uveitis with diverse clinical presentations. All patients were men who have sex with women, and were aged 19-68 years, and none were HIV-positive. All cases were bilateral. One case presented with anterior uveitis, while three exhibited panuveitis. One patient had acute syphilitic posterior placoid chorioretinitis and two had retinal vasculitis resulting in damage to the outer retinal and retinal pigment epithelium. The rapid plasma reagin (RPR) test and Treponema pallidum (TP) hemagglutination test were both positive in all cases. Six of eight eyes had improved vision and best-corrected visual acuity better than 20/20 after antibiotic treatment. Serological testing is mandatory for the diagnosis of syphilitic uveitis. Additionally, multimodal imaging, including optical coherence tomography (OCT), fundus autofluorescence (FAF), and fluorescein angiography (FA), can provide useful adjunctive information for early diagnosis and assessment of treatment response.
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Affiliation(s)
- Saori Kawamoto
- Ophthalmology, Hiroshima Prefectural Hospital, Hiroshima, JPN
| | | | - Ikuyo Sada
- Ophthalmology, Hiroshima University, Hiroshima, JPN
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Oh AJ, Fensterwald MR, Spiegel S, Quiros P. Bilateral Disc Edema: Could It Be Syphilis? J Neuroophthalmol 2024; 44:e182-e183. [PMID: 36648115 DOI: 10.1097/wno.0000000000001754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Angela J Oh
- Department of Ophthalmology (AJO, SS, PQ), Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California; and Department of Neurology (MRF), University of California Los Angeles, Los Angeles, California
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Wu LZ, Orlowski TM, Karunatilake M, Lee S, Mondal P, Kogilwaimath S, Bursztyn LLCD. Prognostic effect of HIV on visual acuity in ocular syphilis: a systematic review. Eye (Lond) 2023; 37:3271-3281. [PMID: 36944709 PMCID: PMC10564912 DOI: 10.1038/s41433-023-02504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND/OBJECTIVES Ocular syphilis is a vision-threatening disease that can lead to permanent blindness if left untreated. The global re-emergence of syphilis warrants greater investigations into the visual prognosis of eyes affected by this potentially devastating disease. This systematic review investigates the impact of HIV on visual acuity (VA) outcomes in ocular syphilis. METHODS A literature search of Medline, PubMed, Embase, Clinicaltrials.gov and Cochrane Reviews was conducted for studies published between 01 January 2011 and 19 March 2022, reporting non-aggregate initial and post-treatment VA data of eyes with ocular syphilis and corresponding HIV status in patients ≥ 18 years. RESULTS A total of 95 studies, including 364 patients and 568 eyes, were evaluated. Among people living with HIV with a diagnosis of ocular syphilis, affected eyes were more likely to have optic nerve involvement and panuveitis. However, HIV status, CD4 cell count, and HIV viral load were not predictive of VA outcomes of treated ocular syphilis. Prognostic factors of final VA worse than 1.00 logMAR were female sex, the presence of macular edema, and VA ≥ 1.00 at presentation. The strongest predictor of a worse final VA was VA ≥ 1.00 at presentation. CONCLUSIONS This systematic review demonstrates that HIV status, CD4 cell count, and HIV viral load are not significant factors impacting VA outcomes of eyes with ocular syphilis. While visual prognosis is generally good, poor visual outcome is most strongly predicted by poor VA at presentation. This underscores the importance of early recognition and treatment prior to permanent vision loss.
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Affiliation(s)
- Laura Z Wu
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Malshi Karunatilake
- Department of Ophthalmology & Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephen Lee
- Division of Infectious Diseases, University of Saskatchewan, Regina, SK, Canada
| | - Prosanta Mondal
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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Shi M, Luo D, Li Z, Li M, Jin S, Yang D, Guo J, Chen G. A case report of neurosyphilis coexisting with a positive MOG antibody manifested as optic neuritis. Front Neurol 2023; 14:1258043. [PMID: 37859651 PMCID: PMC10583717 DOI: 10.3389/fneur.2023.1258043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Background Neurosyphilis refers to an infection of the central nervous system by Treponema pallidum. The clinical manifestations of neurosyphilis are diverse, making it easy to miss or misdiagnose. Anti-myelin oligodendrocyte glycoprotein antibody-associated disease is a recently defined immune-mediated inflammatory demyelinating central nervous system disease. Few studies have reported the coexistence of the two diseases. Case presentation This case report presents a 37 years-old male patient with neurosyphilis manifested as optic neuritis with a positive myelin oligodendrocyte glycoprotein (MOG) antibody. This patient received intravenous administration of 3.2 million units of procaine penicillin every 4 h for 2 weeks, followed by a two-week intramuscular injection of benzathine penicillin. Additionally, methylprednisolone sodium succinate was administered intravenously at 1,000 mg/day, gradually reduced to 500 mg/day and 240 mg/day every 3 days. Subsequently, prednisone tablets at a dosage of 60 mg/day were orally administered, with a gradual reduction of 5 mg/day every 3 days until reaching a dosage of 30 mg/day. The patient's visual acuity was improved after 26 days of hospitalization. However, the visual field and color vision did not. At 3 months of follow-up, the symptoms remained unchanged despite the patient continued taking oral prednisone tablets at a dosage of 30 mg/day. Conclusion Neurosyphilis could be a potential triggering factor for MOGAD. In patients with neurosyphilis, it is strongly recommended to perform testing for MOG antibody along with other brain disease antibodies.
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Affiliation(s)
- Min Shi
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Danqing Luo
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhaoying Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Man Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuoguo Jin
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Guo
- Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Guo Chen
- Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Kaya P, Özdal PÇ. A Case of Syphilis with a Rare Finding: Subretinal Hypopyon. Ocul Immunol Inflamm 2023; 31:1315-1319. [PMID: 36735755 DOI: 10.1080/09273948.2023.2168702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE To report clinical features and follow-up of a case with subretinal hypopyon due to syphilis infection. CASE PRESENTATION We present a case of syphilis admitted with optic neuritis and treated with intravenous pulse steroids without antibiotics. The patient was referred to the uvea clinic in the follow-up because of decreased vision and the onset of multiple retinitis foci. We determined subretinal hypopyon in the left eye and a positive TPHA test. A significant regression was observed in retinitis and hypopyon with antibiotic therapy. CONCLUSION Before starting a steroid treatment, infective etiologies should be considered in patients with optic neuritis. Treating with a high dosage of steroids without antibiotics in syphilis would worsen the clinical features and prognosis.
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Affiliation(s)
- Pınar Kaya
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pınar Çakar Özdal
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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7
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Klimova A, Brichova M, Heissigerova J, Rihova E, Svozilkova P. Trends in management of ocular syphilis in tertiary uveitis centre in Prague, Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:281-287. [PMID: 36124438 DOI: 10.5507/bp.2022.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS To analyse the hallmarks of ocular manifestations of and therapeutic modalities for syphilis in the last two decades. The clinical features of syphilitic uveitis, and association with the human immunodeficiency virus (HIV) coinfection are described. METHODS Retrospective study of 16 patients diagnosed with ocular syphilis confirmed by serological tests in the General University Hospital in Prague between the years 2004 and 2021. General characteristics of ocular and systemic manifestations and visual functions were analysed. RESULTS An increasing incidence of syphilitic uveitis correlates with a general rise in syphilis cases. In our study, the ocular manifestation of syphilis was panuveitis (44%), posterior uveitis (31%) and anterior uveitis (25%). Posterior uveitis was found in 3 patients (19%) associated with preretinal infiltrates, that are often present in syphilitic uveitis. The worst visual outcomes were among patients with human immunodeficiency virus (HIV) coinfection and/or neurosyphilis, however the data were not significant. Optic disc edema was present in 56%, macular involvement in 37% of patients. Overall, 31% of patients in our cohort had persistent visual field defects due to impairment of their optic nerve or macula despite the final median Snellen visual acuity of 1.0. Two out of sixteen patients were treated with corticosteroids in addition to antibiotics. CONCLUSION Posterior uveitis with preretinal infiltrates and optic disc edema should arouse suspicion of ocular syphilis. Recent data show the advantages of adjacent systemic corticosteroid treatment for severe forms of syphilitic uveitis and/or neuritis. Our observation supports this finding.
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Affiliation(s)
- Aneta Klimova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michaela Brichova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Rihova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petra Svozilkova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Thenappan A, Nanda A, Lee CS, Lee SY. Retinitis Pigmentosa Masquerades: Case Series and Review of the Literature. J Clin Med 2023; 12:5620. [PMID: 37685687 PMCID: PMC10489117 DOI: 10.3390/jcm12175620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Retinitis pigmentosa (RP) displays a broad range of phenotypic variations, often overlapping with acquired retinal diseases. Timely recognition and differentiation of RP masquerades is paramount due to the treatable nature of many such conditions. This review seeks to present examples of pseudo-RP cases and provide a comprehensive overview of RP masquerades. We first present two pseudo-RP cases, including comprehensive clinical histories and multimodal retinal imaging, to highlight the important role of accurate diagnoses that subsequently steered effective intervention. Subsequently, we conduct an in-depth review of RP masquerades to provide valuable insights into their key distinguishing features and management considerations. The recent approval of ocular gene therapy and the development of investigational gene-based treatments have brought genetic testing to the forefront for RP patients. However, it is important to note that genetic testing currently lacks utility as a screening tool for inherited retinal diseases (IRDs), including RP. The integrity of a precise clinical assessment remains indispensable for the diagnosis of both RP and RP masquerade conditions, thereby facilitating prompt intervention and appropriate management strategies.
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Affiliation(s)
- Abinaya Thenappan
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arjun Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Chang Sup Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics and Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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9
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Kayabaşı M, Köksaldı S, Saatci AO, Bajin MS. Presentation of Ocular Syphilis with Bilateral Optic Neuropathy. Neuroophthalmology 2023; 47:274-280. [PMID: 38130808 PMCID: PMC10732629 DOI: 10.1080/01658107.2023.2222800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 12/23/2023] Open
Abstract
A 60-year-old otherwise healthy male presented with a 1 year history of bilateral progressive visual loss. His best-corrected visual acuity was counting fingers at 2 m with his right eye and counting fingers at 0.5 m with his left eye. Visual field testing revealed bilateral near-total loss of visual fields. Slit-lamp examination was unremarkable, apart from bilateral grade two nuclear sclerotic cataracts. Both optic discs were pale-looking with some retinal pigment epithelial alterations at the left papillomacular region. Enhanced depth imaging optical coherence tomography depicted punctate hyperreflective dots at the inner choroidal level corresponding to the retinal pigment epithelial changes in the left eye. Fundus autofluorescence imaging revealed patchy hyper-autofluorescent and hypo-autofluorescent areas, and there was mild staining in the early and late phases of the fluorescein angiogram at the papillomacular region in the left eye. A diagnosis of bilateral optic neuropathy was made. A full systemic work-up was carried out, and serological tests pointed out the presence of syphilis with normal cranial magnetic resonance imaging. He was treated accordingly. Our case clearly demonstrates the importance of a high clinical suspicion for syphilis in cases of optic neuropathy.
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Affiliation(s)
- Mustafa Kayabaşı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Seher Köksaldı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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11
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Acute syphilitic posterior placoid chorioretinitis as the presenting symptom of syphilis in an immunocompetent patient. Am J Ophthalmol Case Rep 2022; 28:101695. [PMID: 36217438 PMCID: PMC9547151 DOI: 10.1016/j.ajoc.2022.101695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2022] [Accepted: 08/28/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Observations Conclusions and Importance
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12
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[Translated article] Ocular Syphilis Diagnosed After Evaluation of Key Skin Signs: A Case Report. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Luna-Bastante L, Vergara-de-la-Campa L, Martínez-Lorenzo E, Clavo-Escribano P. Sífilis ocular, cuando la piel es clave. Presentación de un caso clínico. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:737-739. [DOI: 10.1016/j.ad.2020.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/19/2020] [Accepted: 11/24/2020] [Indexed: 10/19/2022] Open
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14
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Sun CB, Liu GH, Wu R, Liu Z. Demographic, Clinical and Laboratory Characteristics of Ocular Syphilis: 6-Years Case Series Study From an Eye Center in East-China. Front Immunol 2022; 13:910337. [PMID: 35757732 PMCID: PMC9226556 DOI: 10.3389/fimmu.2022.910337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the demographic, clinical, and laboratory characteristics of ocular syphilis based on a 6-year case series study from an eye center in East-China. Methods A total of 131 cases (191 eyes) of ocular syphilis and the annual number of total syphilis cases from January 2016 to December 2021, were included in this study. Detailed medical records including systemic and ophthalmic medical history, a complete ophthalmic examination, color fundus photography, B-type ultrasound, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT), laboratory tests of the serum and cerebrospinal fluid (CSF) samples, as well as visual field test and orbital or cranial MRI in cases with suspected optic neuritis or optic atrophy, were collected and analyzed. Pearson Chi-square or Fisher’s exact tests was used for statistics analysis. Results Of the 131 cases with ocular syphilis, 86 cases were in men and 6 cases had a past medical history or systemic manifestation of syphilis. HIV was found in only 2 of 70 cases undergoing serum HIV test. The average age was 54.0 years, ranging from 26–85 years. The average percentage of ocular syphilis out from the total syphilis cases was 5.1%, the average titer of serum rapid plasma regain (RPR) at presentation was 1:32, ranging from 1:1–1:512. The most predominant manifestation of ocular syphilis was posterior uveitis, followed by optic neuritis, optic atrophy, panuveitis, retinal vasculitis, and retinitis. The median of BCVA of all 191 eyes was 20/200 (ranging from no light perception to 20/20), and 20/40 (ranging from no light perception to 20/20) at presentation and final follow-up, respectively. Ocular syphilis with active inflammation responded well to penicillin therapy, no matter the initial visual acuity, ocular disease type, or RPR titers, as long as it was diagnosed early and treated properly and promptly. However, cases with optic atrophy, acute retinal necrosis, late diagnosis, permanent disruption, or loss of outer segment of photoreceptors of macular retina on SD-OCT showed poor visual improvement after therapy. Conclusions Early diagnosis of ocular syphilis is still challenging in clinical practice and syphilis tests should be routinely performed in patients with uveitis, retinitis, optic neuritis, and optic atrophy.
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Affiliation(s)
- Chuan-Bin Sun
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Geng-Hao Liu
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Rong Wu
- Custom Service Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Liu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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15
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Orman G, Sungur G. Ophthalmologic Assesment of Patients with Syphilitic Optic Neuropathy. Ocul Immunol Inflamm 2022; 31:760-767. [PMID: 35442838 DOI: 10.1080/09273948.2022.2046791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the different clinical findings and symptoms of patients with optic neuritis (ON) and uveitis, who were diagnosed with syphilis. METHODS The medical records of patients, who had ocular involvement of syphilis, were retrospectively reviewed. Thirteen patients with syphilitic optic neuropathy (SON) were enrolled and underwent complete ophthalmological examinations and auxiliary laboratory testing. RESULTS Nine patients (69.2%) had comorbidities in addition to syphilis. One patient (with two eyes) presented with retrobulbar neuritis, and 12 patients (with 17 eyes) presented with anterior optic neuritis. Three patients (23.1%) had no uveitis, and 10 patients (76.9%) had uveitis in cases with SON. Four eyes (16.6%) had subretinal fluid, and three eyes (12.5%) had cystoid macular edema. CONCLUSIONS Visual function can be preserved with early diagnosis and proper treatment. Accordingly, newly diagnosed patients with ON and uveitis should undergo syphilitic investigation in routine practice.
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Affiliation(s)
- Gözde Orman
- Department of Ophthalmolgy, Health Science University Ankara Researching and Training Hospital, Ankara, Turkey
| | - Gülten Sungur
- Department of Ophthalmolgy, Health Science University Ankara Researching and Training Hospital, Ankara, Turkey
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16
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Begaj T, Sobrin L. Ophthalmic Consequences of Syphilis. Int Ophthalmol Clin 2022; 62:251-268. [PMID: 35325922 DOI: 10.1097/iio.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Paiva ADCM, Britto VSD, Criado GG, Simões KMP, Motta MMDS. Pseudoretinitis pigmentosa due to syphilis: a case report and literature review. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Jahnke S, Lange CSD, Wienrich R, Kreft B. Okuläre Syphilis - eine Fallserie von vier Patienten. J Dtsch Dermatol Ges 2021; 19:987-992. [PMID: 34288478 DOI: 10.1111/ddg.14464_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Stephanie Jahnke
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle- Wittenberg, Halle (Saale)
| | - Cord Sunderkötter Danica Lange
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle- Wittenberg, Halle (Saale)
| | - Ricarda Wienrich
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Burkhard Kreft
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle- Wittenberg, Halle (Saale)
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19
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Ducloyer JB, Marignier R, Wiertlewski S, Lebranchu P. Optic neuritis classification in 2021. Eur J Ophthalmol 2021; 32:11206721211028050. [PMID: 34218696 DOI: 10.1177/11206721211028050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.
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Affiliation(s)
| | - Romain Marignier
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon, Auvergne-Rhône-Alpes, France
| | | | - Pierre Lebranchu
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France
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20
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Kabanovski A, Jeeva-Patel T, Kaplan A, Bui E, Margolin EA. Older woman with abdominal pain and bilateral sequential vision loss due to syphilis. BMJ Case Rep 2021; 14:14/6/e243847. [PMID: 34193456 DOI: 10.1136/bcr-2021-243847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 62-year-old woman presented with non-specific abdominal pain, elevated alkaline phosphatase levels and bilateral sequential visual loss. Visual acuity was counting fingers in right eye (RE) and 20/400 in left eye (LE). She was noted to have optic nerve pallor in RE and mildly elevated optic disc with signs of ocular inflammation in LE. After 2 weeks, vision deteriorated to light perception bilaterally with now extensive vitreal inflammation present in both eyes. Positive rapid plasma reagen and Treponema pallidum's antibody tites confirmed syphilis infection. Unfortunately, as the diagnosis was delayed by many months, her visual acuity remained poor (hand motions in RE and 20/50 in LE) despite treatment with intravenous penicillin. This case reminds us of the re-emergence of this 'great masquerader' and highlights the importance of maintaining high suspicion for syphilis in patients with unexplained visual loss and systemic symptoms, even in older adults without identifiable risk factors.
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Affiliation(s)
- Anna Kabanovski
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Trishal Jeeva-Patel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Esther Bui
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Edward A Margolin
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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21
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Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, Gordon DL, Smith JR. Ocular syphilis. Surv Ophthalmol 2021; 67:440-462. [PMID: 34147542 DOI: 10.1016/j.survophthal.2021.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
Multiple studies around the world suggest that syphilis is re-emerging. Ocular syphilis - with a wide range of presentations, most of which are subtypes of uveitis - has become an increasingly common cause of ocular inflammation over the past 20 years. Its rising incidence, diagnostic complexity, and manifestations that have only recently been characterized make ocular syphilis relevant from the public health, clinical, and scientific perspectives. We review the demographics, epidemiology, clinical features, ocular imaging findings, diagnosis, and medical management of this condition.
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Affiliation(s)
- João M Furtado
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Milena Simões
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Daniel Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Genevieve F Oliver
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Mudit Tyagi
- Ocular Inflammation and Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Heloisa Nascimento
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia-IPEPO, São Paulo, Brazil
| | - David L Gordon
- Flinders University College of Medicine and Public Health, Adelaide, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, South Australia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
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22
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James S, Thozhuthumparambil KP. Bilateral optic disc swelling resulting from lymphocytic meningitis and posterior uveitis secondary to syphilis. BMJ Case Rep 2021; 14:14/5/e239813. [PMID: 34011659 DOI: 10.1136/bcr-2020-239813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is being diagnosed more often in the UK due to the rise in obesity. In fact, patients who present with bilateral optic disc swelling are habitually put on the papilloedema pathway, often without consideration of other diagnoses. We report the case of a middle-aged woman diagnosed with papilloedema and managed as IIH, until, cerebrospinal fluid (CSF) analysis revealed evidence of lymphocytic meningitis secondary to syphilis. The patient was treated successfully with intravenous antibiotics. Syphilis is the great masquerader and should be a diagnosis to consider in patients who have CSF findings incongruent with their clinical presentation.
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Affiliation(s)
- Sunil James
- Acute Medical Unit, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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23
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Jahnke S, Sunderkötter C, Lange D, Wienrich R, Kreft B. Ocular syphilis - a case series of four patients. J Dtsch Dermatol Ges 2021; 19:987-991. [PMID: 33951294 DOI: 10.1111/ddg.14464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 01/18/2023]
Abstract
Ocular manifestations of syphilis with visual impairment symptoms may occur already at the stage of secondary syphilis. They may also be the only manifestation of syphilis and mimic other diseases of the eye. Therefore, in all patients with uveitis, optic neuritis, optic atrophy, acute ocular muscle paresis, or loss of visual acuity, syphilis infection should be ruled out, even if the medical history does not initially raise suspicion. Ocular involvement should be treated as neurosyphilis. Delayed diagnosis and inadequate therapy are often associated with irreversible consequences for the affected patient. As with any syphilis infection, HIV infection should be considered and excluded, especially in the case of ocular manifestations.
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Affiliation(s)
- Stephanie Jahnke
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Cord Sunderkötter
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Danica Lange
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ricarda Wienrich
- University Hospital and Clinic for Ophthalmology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Burkhard Kreft
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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24
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Marchese A, Agarwal AK, Erba S, Scialdone A, Miserocchi E, Bandello F, Introini U, Jampol LM, Casalino G. Placoid lesions of the retina: progress in multimodal imaging and clinical perspective. Br J Ophthalmol 2021; 106:14-25. [PMID: 33468489 DOI: 10.1136/bjophthalmol-2020-318337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Placoid lesions of the retina may be secondary to a wide spectrum of acquired inflammatory conditions that have been reported as single entities with different presentation and clinical course. These conditions include acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, serpiginous-like choroiditis, relentless placoid chorioretinitis and acute syphilitic posterior placoid chorioretinitis. In this article, we will group these conditions under the name of 'placoids'. The recognition of the specific condition may be challenging in clinical practice, often resulting in diagnostic and therapeutic delay. Given the complex nature of placoids and their similarities, a systematic approach including differentiating between infectious and non-infectious aetiologies increases the chance of reaching the correct diagnosis. Detailed history and comprehensive clinical examination are the first steps to formulate a diagnostic hypothesis that should be corroborated by multimodal imaging and appropriate investigations. The advent of multimodal imaging has made it possible to extensively study placoids and revealed a constellation of specific findings that may help clinicians in the diagnostic process. The treatment of the conditions other than syphilis is complex and sometimes challenging. Our article is aimed at giving an overview of the individual entities associated with placoids and discussing the differential diagnosis. A practical and systematic approach is then proposed.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Stefano Erba
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Elisabetta Miserocchi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Ugo Introini
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
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25
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Weng W, Hou J, Song B, Zhang M, Zhang T, Gao Y. Identification of the factors associated with post-treatment asymptomatic neurosyphilis in HIV-negative patients with serological non-response syphilis: a retrospective study. Int J STD AIDS 2020; 32:331-335. [PMID: 33345747 DOI: 10.1177/0956462420965850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some syphilis patients do not exhibit an appropriate serological response after treatment despite the absence of any clinical evidence of treatment failure or reinfection. This condition is called "serofast syphilis" or "serological non-response syphilis." This study explored the incidence of asymptomatic neurosyphilis (ANS) and related factors in 324 asymptomatic patients with serological non-response syphilis. We analyzed descriptive statistics stratified by the presence of asymptomatic neurosyphilis for the basic characteristics of samples. Bivariate analysis was conducted to assess correlations between outcomes and potential predictors. Variables significant in the bivariate analysis (p<0.1) were entered into multivariable logistic regression models. All p-values were two-sided with a significance threshold of p<0.05. The results indicated that 89 of 324 patients had ANS (incidence of 27.5%), and the greatest risk factors were a < fourfold decrease in serum rapid plasma reagin (RPR) titers after treatment and current serum RPR titers >1:32. Our findings suggest that ANS is common among syphilis patients, and patients with a fourfold decrease in serum RPR titers after treatment and current serum RPR titers >1:32 are more likely to develop ANS.
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Affiliation(s)
- Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiahua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bingbing Song
- Department of Dermatology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Yanqing Gao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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26
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Queiroz RDP, Smit DP, Peters RPH, Vasconcelos-Santos DV. Double Trouble: Challenges in the Diagnosis and Management of Ocular Syphilis in HIV-infected Individuals. Ocul Immunol Inflamm 2020; 28:1040-1048. [PMID: 32657637 DOI: 10.1080/09273948.2020.1772839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Syphilis and HIV infection may coexist in the same individual. Ocular syphilis and/or neurosyphilis may develop at any stage of coinfection, with a stronger association between ocular and neurosyphilis in individuals living with HIV, than in HIV-uninfected individuals. The diagnosis of ocular syphilis in HIV-infected and -uninfected patients remains with some controversy due to unspecific clinical manifestations and limited diagnostic tests. Penicillin is the mainstay of treatment of ocular syphilis, but alternative options are warranted. This review describes the epidemiology, pathophysiology, and clinical manifestations, as well as the diagnostic and therapeutic challenges posed by ocular syphilis against the background of HIV coinfection.
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Affiliation(s)
- Rafael de Pinho Queiroz
- Department of Ophthalmology and Otolaryngology, Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil.,Uveitis Unit, Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Remco P H Peters
- Foundation for Professional Development, Research Unit , East London, South Africa.,Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,CAPHRI School of Public Health & Primary Care, Maastricht University Medical Centre , Maastricht, The Netherlands
| | - Daniel Vitor Vasconcelos-Santos
- Department of Ophthalmology and Otolaryngology, Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil.,Uveitis Unit, Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
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27
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Casalino G, Erba S, Sivagnanavel V, Lari S, Scialdone A, Pavesio C. Spontaneous resolution of acute syphilitic posterior placoid chorioretinitis: reappraisal of the literature and pathogenetic insights. GMS OPHTHALMOLOGY CASES 2020; 10:Doc26. [PMID: 32676271 PMCID: PMC7332998 DOI: 10.3205/oc000153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare clinical manifestation of ocular syphilis. Spontaneous resolution of this condition has been reported in a few cases. The aim of this manuscript is to report an additional case and to discuss the possible pathogenesis of this condition by reviewing the current evidence on this subject. A 45-year-old man presented to us with decreased vision in the right eye secondary to a placoid macular lesion. Fourteen days after presentation, there was a dramatic improvement of the vision, and multimodal retinal imaging showed almost complete spontaneous resolution of the placoid lesion. Syphilis serology turned out positive and a diagnosis of ASPPC was made. The pathogenesis of ASPPC is unclear, and there is contrasting evidence about the role of the cellular immune system. Since this condition may resolve spontaneously before systemic antimicrobial treatment, the presence of a placoid macular lesion should raise a high suspicion of ASPPC in order to make a timely diagnosis and to avoid progression of untreated syphilis.
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Affiliation(s)
| | - Stefano Erba
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Shervin Lari
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | | | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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28
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Denouement. Pediatr Infect Dis J 2020; 39:174-175. [PMID: 31929438 DOI: 10.1097/01.inf.0000653772.38924.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Abstract
Purpose: To review the broad spectrum of clinical neuro-ophthalmic presentations associated with human immunodeficiency virus (HIV) infection. Methods: Critical review of the literature regarding neuro-ophthalmic consequences of HIV infection and its sequelae. Results: Neuro-ophthalmological diseases are common in both asymptomatic HIV-positive patients and those who profound immunosuppression with acquired immune deficiency syndrome (AIDS). Neuro-ophthalmic manifestations of HIV infection can involve the afferent or efferent visual pathway. Common clinical presentations include headache, papilledema, chorioretinitis, optic nerve involvement, meningitis, and cranial nerve palsies. Other neuro-ophthalmic manifestations include involvement of the visual pathway in the brain producing visual field defects such as occur in progressive multifocal encephalopathy. Pupil abnormalities have also been reported. Discussion: Neuro-ophthalmic consequences of HIV are important to recognize as it is critical to identify underlying neoplastic or infectious diseases which could be amenable to treatment.
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Affiliation(s)
- Lynn K Gordon
- Department of Ophthalmology Stein Eye Institute, David Geffen School of Medicine at UCLA , Los Angeles, CA, USA
| | - Helen Danesh-Meyer
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
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30
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Yosar J. Neurosyphilis presenting as visually asymptomatic bilateral optic perineuritis. BMJ Case Rep 2019; 12:12/12/e232520. [PMID: 31871011 DOI: 10.1136/bcr-2019-232520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A 39-year-old Caucasian man presented with headaches and retro-orbital pain but normal vision. Bilateral optic nerve swelling was found on funduscopy though optic nerve function and computed perimetry were normal and there was no relative afferent pupillary defect. CT venogram and MRI were unremarkable. Cerebrospinal fluid (CSF) opening pressure was normal on lumbar puncture and Treponema pallidum antibodies and T. pallidum particle agglutination test were positive on CSF analysis. He tested negative for HIV. Symptoms rapidly resolved with 2 weeks of intravenous benzylpenicillin. At 1 month follow-up, the right optic nerve swelling had reduced while the left optic nerve swelling had increased; his vision remained unaffected and he was symptom free and continued to have no objective evidence of optic nerve dysfunction.
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Affiliation(s)
- Jason Yosar
- Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
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31
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Trevelyan G, Kumar K, Russell GK, Wickremasinghe M. Secondary syphilis presenting with acute unilateral vision loss and a widespread maculopapular rash. BMJ Case Rep 2019; 12:12/9/e230341. [PMID: 31537590 DOI: 10.1136/bcr-2019-230341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Syphilis infection has shown a marked resurgence over the past several years. Ocular involvement is a rare complication of syphilis, occurring in approximately 1% of cases. We present the case of a man in his 50s who presented to hospital with acute unilateral vision loss and a widespread maculopapular rash. Ophthalmological examination showed unilateral optic disc swelling and bilateral vitritis. Intracranial imaging revealed no acute pathology. Initial blood tests were normal apart from mildly elevated inflammatory markers. A comprehensive autoimmune and infection screen revealed positive syphilis serology. The patient was subsequently treated for syphilis with ocular involvement with a course of intravenous benzylpenicillin, resulting in rapid symptomatic improvement. This case highlighted the importance of considering syphilis infection as part of the differential diagnosis for unexplained multisystemic symptoms, such as loss of vision in combination with dermatological involvement.
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Affiliation(s)
- Gareth Trevelyan
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Kartik Kumar
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Georgina K Russell
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Melissa Wickremasinghe
- Department of Respiratory Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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