Abstract
IntroductionSyphilis is well known as an infectious disease which can present with a large variety of symptoms. Clinical diagnosis can be difficult and may be complicated in modern medicine by immunosuppressive treatment and possible side effects of medication.Case presentationWe describe a rare case of placoid chorioretinitis due to Treponema pallidum which developed after the primary symptom of proteinuria was not recognized as a rare manifestation of syphilis. Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene obtained from vitreous after diagnostic vitrectomy.ConclusionThis case shows that clinicians should be alert in patients with proteinuria and chorioretinitis as they can represent rare manifestations of syphilis. Syphilis should be in the differential diagnosis of any unknown symptom and in the presumed side effects of medication.
Highlights
Syphilis is well known as an infectious disease which can present with a large variety of symptoms
Case presentation: We describe a rare case of placoid chorioretinitis due to Treponema pallidum which developed after the primary symptom of proteinuria was not recognized as a rare manifestation of syphilis
Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene obtained from vitreous after diagnostic vitrectomy
Summary
This case illustrates the difficulties in diagnosing syphilis in a situation, where the initial manifestation of infection was unusual (mild nephrotic syndrome), obvious sexual risk factors like prostitution were absent, and more typical symptoms of syphilis (e.g., palmar erythema, hair loss) could be interpreted as medicationinduced complications. Considering the chameleonic behaviour of syphilis and its recent increase in the Western World [14], specific questioning and serological testing for syphilis should always be performed whenever the etiology of organ symptoms remains unclear
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