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Sifuentes Rentería SE, Rodríguez Badillo P, Valdez González T. Multimodal Imaging Features of the Posterior Segment in Ocular Syphilis and HIV Co-Infection: A Single Center Case Series. Ocul Immunol Inflamm 2024; 32:1335-1341. [PMID: 37590885 DOI: 10.1080/09273948.2023.2244073] [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: 02/16/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To analyze the frequent multimodal imaging features in posterior syphilitic uveitis. PURPOSE Syphilis infection has re-emerged as a global health problem. Multimodal imaging approach has been proposed for diagnosis and follow-up; there are not previous reports dedicated to the anatomic and visual outcomes in patients diagnosed with ocular syphilis and concomitant HIV infection. METHODS All demographic information was recovered; a complete ophthalmological examination and multimodal imaging evaluation (retinal fluorescein angiography (FA), autofluorescence (AF), optical coherence tomography (OCT)) were performed on initial visit and 1 month after antibiotic therapy. RESULTS 18 eyes of 9 patients were included. The most frequent features observed were: Hyperfluorescence on optic disk on FA, Hyperautofluorescence punctate pattern on AF, Vitritis on SD-OCT. After treatment, there was a functional and anatomical improvement. CONCLUSION Ocular syphilis represents a diagnostic challenge. Multimodal imaging approach allows identification of structural changes, follow-up and early detection of complications.
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Affiliation(s)
| | - Paulina Rodríguez Badillo
- Inflammatory Ocular Diseases Department, Foundation Hospital Nuestra Señora de la Luz (FHNSL), Mexico City, Mexico
- Ophthalmology Department, Clinica Especializada Condesa - Iztapalapa (CECI), Mexico City, Mexico
| | - Teresa Valdez González
- Inflammatory Ocular Diseases Department, Foundation Hospital Nuestra Señora de la Luz (FHNSL), Mexico City, Mexico
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Gomes E Silva A, Alcântara Pedroso L, Veiga Costa F, de Moraes Perlingeiro R, Peixoto de Castro Oliveira P, Biancardi Barreto AL, Luiz Land Curi A. Intravenous Ceftriaxone on an Outpatient Basis in the Treatment of Ocular Syphilis. Ocul Immunol Inflamm 2024; 32:1284-1286. [PMID: 37582224 DOI: 10.1080/09273948.2023.2232443] [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: 02/10/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE The goal of this study is to describe the clinical and laboratory outcomes of patients with syphilitic uveitis treated with 2 g intravenous Ceftriaxone daily on an outpatient treatment basis for 14 days, in the setting of the COVID pandemic and lack of hospitalization availability. METHODS This study included a review of the clinical records from patients from January 2020 to December 2021 and who were then followed for 6 months at the Research Laboratory of Infectious Diseases in Ophthalmology of the National Institute of Infectious Diseases Evandro Chagas (INI) FIOCRUZ, Rio de Janeiro, Brazil. CONCLUSION This study showed that almost all of the 15 patients were well treated for ocular syphilis with Ceftriaxone without any signs of therapeutic failure with documented clinical improvement and satisfactory decreasing VDRL titers.
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Affiliation(s)
- Amanda Gomes E Silva
- Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Leticia Alcântara Pedroso
- Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Flavia Veiga Costa
- Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | | | | | - Ana Luisa Biancardi Barreto
- Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Andre Luiz Land Curi
- Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases, Rio de Janeiro, Brazil
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Li M, Yao B, Xu E, Fang Y, Yang W, Li G. Acute syphilitic posterior placoid chorioretinitis in a woman. QJM 2024; 117:465-467. [PMID: 38457609 DOI: 10.1093/qjmed/hcae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Indexed: 03/10/2024] Open
Affiliation(s)
- M Li
- Department of Ophthalmology, Qidong People's Hospital, Affiliated Qidong Hospital of Nantong University, Qidong Liver Cancer Institute, Nantong, China
| | - B Yao
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - E Xu
- Department of Ophthalmology, Qidong People's Hospital, Affiliated Qidong Hospital of Nantong University, Qidong Liver Cancer Institute, Nantong, China
| | - Y Fang
- Department of Ophthalmology, Qidong People's Hospital, Affiliated Qidong Hospital of Nantong University, Qidong Liver Cancer Institute, Nantong, China
| | - W Yang
- Department of Ophthalmology, Qidong People's Hospital, Affiliated Qidong Hospital of Nantong University, Qidong Liver Cancer Institute, Nantong, China
| | - G Li
- Department of Ophthalmology, Qidong People's Hospital, Affiliated Qidong Hospital of Nantong University, Qidong Liver Cancer Institute, Nantong, China
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Mirzania D, Zacks DN, Zhou Y, Huvard MJ. Clinical Characteristics and Visual Outcomes of Acute Syphilitic Posterior Placoid Chorioretinopathy. Ophthalmol Retina 2023; 7:1080-1086. [PMID: 37479085 DOI: 10.1016/j.oret.2023.07.014] [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: 04/28/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To evaluate presenting features and visual outcomes in eyes with acute syphilitic posterior placoid chorioretinopathy (ASPPC). DESIGN Retrospective cohort study. SUBJECTS A total of 24 eyes of 17 adult patients with ASPPC. METHODS Chart review of patients with ASPPC who presented to the University of Michigan W. K. Kellogg Eye Center between January 1, 2012, and November 4, 2022. Demographic and clinical information, fundus photographs, fundus autofluorescence, and spectral-domain-OCT (SD-OCT) findings were reviewed. MAIN OUTCOME MEASURES Clinical characteristics and visual acuity (VA) on presentation and follow-up examination. RESULTS The median age was 46 (interquartile range [IQR], 38-51) years. At presentation, 20 (83.3%) eyes had subjectively decreased vision, with a median initial VA of 0.54 (IQR, 0.35-1.00) logarithm of the minimum angle of resolution (logMAR); at 45 days, median logMAR VA was 0.096 (IQR, 0.02-0.17). Initial VA was positively associated with posterior pole-sparing lesions (coefficient estimate [CE], -0.75; 95% confidence interval [CI], -1.38 to -0.12); P = 0.03), and negatively associated with ellipsoid zone (EZ) disruption (CE, 0.72; 95% CI, 0.03-1.42; P = 0.04), subfoveal EZ disruption (CE, 0.62; 95% CI, 0.02-1.23; P = 0.046), and initial hyperreflective foci on SD-OCT (CE, 0.66; 95% CI, 0.09-1.23; P = 0.03). Female eyes were more likely (hazard ratio [HR], 3.36; 95% CI, 1.07-10.6; P = 0.04), and eyes with optic nerve abnormality were less likely (HR, 0.34; 95% CI, 0.12-0.96; P = 0.04), to achieve a VA ≥ 20/40 (logMAR, 0.30). CONCLUSIONS This study of patients with ASPPC showed that symptomatic eyes had an improvement from a median VA of 20/69 on presentation to a median VA of 20/25 at 45 days. Female sex and absence of optic nerve involvement were associated with higher probability of achieving ≥ 20/40. These findings provide refined guidance for counseling patients who present with decreased vision due to ASPPC. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Delaram Mirzania
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan.
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Sugiyama R, Ohnishi T, Yamagami S, Nagaoka T. A case of acute syphilitic posterior placoid chorioretinitis showing improved choroidal blood flow after treatment. Am J Ophthalmol Case Rep 2023; 32:101880. [PMID: 37456147 PMCID: PMC10339182 DOI: 10.1016/j.ajoc.2023.101880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare form of ocular syphilis. However, its pathophysiology is not fully understood. Laser speckle flowgraphy (LSFG) can facilitate the non-invasive evaluation of blood flow and allow investigations into the effects of treatments in various ocular diseases. We report a case of ASPPC that presented with symptoms only in the right eye but showed bilateral disease in LSFG. Observations A 54-year-old man presented with decreased vision and visual field defects in the right eye 2 days prior to the initial visit. Fundoscopy images showed a typical yellowish placoid lesion in the macular area, and optical coherence tomography showed disruption of the outer retinal layers and nodular appearance of the retinal pigment epithelium. Fluorescence angiography showed excessive leakage of the placoid lesion characterized by hypofluorescent dots in the inner area ("leopard spotting"). The patient was diagnosed with unilateral ASPPC based on multiple imaging and serological tests. Penicillin was administered for 2 weeks, and the patient showed improvement in symptoms and restoration of the retinal structure. The mean blur rate of the right/left eye was 2.1/5.9 arbitrary units (AU) before treatment and increased to 4.5/9.3 AU 6 months after treatment. Conclusions and importance Despite the absence of typical imaging signs and symptoms in the left eye, both eyes may have been affected with different degrees of severity. Thus, LSFG may facilitate the evaluation of treatment effects and the prediction of ocular inflammatory diseases in the early stages.
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Affiliation(s)
| | - Takako Ohnishi
- Corresponding author. Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
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Saturno MC, Neri P, Pichi F. Fundus autofluorescence in uveitis: from pathogenesis to imaging interpretation. Int Ophthalmol 2023; 43:4359-4371. [PMID: 37418226 DOI: 10.1007/s10792-023-02803-1] [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: 05/21/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE This review aims to summarize the current fundus autofluorescence (FAF) ailment for diagnosis and follow-up of uveitis. METHODS A thorough literature search was performed in the PubMed database. RESULTS FAF maps the retinal pigment epithelium's (RPE) health. Therefore, several posterior infectious and non. This fast, easy-to-perform, noninvasive technique can detect and manage infectious uveitis. CONCLUSIONS FAF serves to understand pathophysiologic mechanisms of uveitis and is a valuable prognostic indicator of themselves.
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Affiliation(s)
| | - Piergiorgio Neri
- Eye Insitute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Francesco Pichi
- Eye Insitute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Melton M, Thornton A, Pasagic S. An Atypical Presentation of Acute Syphilitic Posterior Placoid Chorioretinitis With Concurrent Psoriasis Vulgaris Flare in an African American Male Infected With HIV. Cureus 2023; 15:e40294. [PMID: 37448438 PMCID: PMC10337511 DOI: 10.7759/cureus.40294] [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: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
The diagnosis of secondary syphilis can be challenging due to its various clinical and histopathological presentations. A late or incorrect diagnosis can result in disease progression with consequent morbidity or mortality. Due to the importance of a correct diagnosis and specific treatment, it is of the utmost importance for healthcare providers to consider the various manifestations of syphilis. We describe an atypical presentation of secondary syphilis in an African American man infected with HIV and chronic psoriasis, who presented with two months of diffuse maculopapular rash and new visual changes, found to have acute syphilitic placoid chorioretinitis (ASPCC) and a psoriasis vulgaris flare.
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Affiliation(s)
| | - Alice Thornton
- Infectious Disease, University of Kentucky, Lexington, USA
| | - Sandro Pasagic
- Internal Medicine, University of Kentucky, Lexington, USA
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Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [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: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
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Lai EW, Dinh RH, Do BK, Schechet SA. Posterior placoid-like maculopathy and macular hole associated with vitamin A deficiency. Am J Ophthalmol Case Rep 2022; 29:101772. [PMID: 36544748 PMCID: PMC9761597 DOI: 10.1016/j.ajoc.2022.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To report a case of bilateral posterior placoid-like maculopathy and a macular hole associated with vitamin A deficiency. Observations A 72-year-old male presented with nyctalopia and progressive vision loss in both eyes. Examination and multimodal imaging were consistent with posterior placoid-like maculopathy bilaterally and a macular hole in the right eye. A workup for infectious, inflammatory, and paraneoplastic etiologies revealed a severely low serum vitamin A level. Two months after initiation of vitamin A repletion, there was improvement in best-corrected Snellen visual acuity as well as macular hole closure. A diagnosis of posterior placoid-like maculopathy in the setting of vitamin A deficiency (VAD) was made. Conclusions and importance VAD should be considered when symmetric posterior pole placoid-like lesions are observed and other, more common etiologies have been ruled out.
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Affiliation(s)
- Eric W. Lai
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Russel H. Dinh
- MedStar Health/Georgetown-Washington Hospital Center, Washington, D.C, USA
| | - Brian K. Do
- MedStar Health/Georgetown-Washington Hospital Center, Washington, D.C, USA,Retina Group of Washington, Washington, D.C, USA
| | - Sidney A. Schechet
- Elman Retina Group, Baltimore, MD, USA,Corresponding author. 9114 Philadelphia Rd. Suite 310, Baltimore, MD, 21237, USA
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Buscho SE, Ishihara R, Gupta PK, Mopuru R. Secondary Syphilis Presenting as Bilateral Simultaneous Papillitis in an Immunocompetent Individual. Cureus 2022; 14:e28465. [PMID: 36176871 PMCID: PMC9511816 DOI: 10.7759/cureus.28465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/05/2022] Open
Abstract
Ocular syphilis is a common presentation for patients with secondary or tertiary syphilis and usually includes posterior uveitis or panuveitis, though a myriad of symptoms have been associated. We report the case of a 58-year-old Caucasian male who presented with fast-progressing vision loss and a new onset of floaters in both eyes. An initial fundus exam revealed only bilateral optic disc edema, and neurological evaluation was negative. Subsequent ophthalmology evaluation in the clinic revealed a ragged retinal pigmented epithelium on optical coherence tomography (OCT) and posterior placoid chorioretinitis, raising suspicion of syphilis. Intravenous penicillin therapy was immediately initiated based on high clinical suspicion of ocular syphilis while awaiting lab confirmation, which was later confirmed as a new syphilis infection. He was subsequently given oral prednisone 48 hours into penicillin therapy for a significant posterior inflammatory response in both his eyes. His visual recovery was drastic due to the timely use of oral steroids. Classical findings such as ragged retinal pigmented epithelium on OCT and posterior placoid chorioretinitis demonstrate strong clinical suspicion of ocular syphilis. Oral prednisone when used timely with penicillin therapy in special situations such as bilateral severe posterior uveitis, panuveitis, or optic neuritis may aid in a faster and smoother visual recovery. A high index of clinical suspicion of ocular syphilis should be maintained in patients with human immunodeficiency virus (HIV) infection presenting with uveitis, posterior placoid morphology, or optic disc edema. Oral prednisone may be an effective adjuvant treatment for immunocompetent patients who mount a strong inflammatory response to ocular syphilis infection.
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Ly V, Elhusseiny AM, Sallam AB. Syphilis-related Ocular Inflammation in HIV-positive and HIV-negative Patients. Ocul Immunol Inflamm 2022:1-6. [PMID: 35880976 DOI: 10.1080/09273948.2022.2082987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the clinical characteristics and visual outcomes of ocular syphilis in human immunodeficiency virus (HIV)-positive and negative patients. METHODS We performed a retrospective chart review of all patients with newly diagnosed ocular syphilis between January 2015 and August 2021. RESULTS 68 eyes of 41 patients (22 eyes in 12 HIV-positive patients, 46 eyes in 29 HIV-negative patients) were included. The most common ophthalmic feature was posterior uveitis in HIV-positive and anterior uveitis in HIV-negative patients; 58.3% (7 out of 12 patients) of HIV-positive and 48.2% (14 out of 29 patients) of HIV-negative patients were diagnosed with neurosyphilis. There were no significant differences in laterality, presence of concurrent rash, rapid plasma reagin (RPR) titers, presenting, and final corrected visual acuity between both groups. CONCLUSION Nearly one-fifth of eyes may suffer from severe visual loss of ≤ 20/200. HIV co-infection may not result in visual outcomes in syphilis.
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Affiliation(s)
- Victoria Ly
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ahmed B Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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