Abstract
IntroductionOcular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia.MethodologyThis was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed.ResultsA total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes.ConclusionsPosterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.
Highlights
Posterior uveitis was the commonest presentation of ocular syphilis in human immunodeficiency virus (HIV)-negative patients
Detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision
Ocular syphilis is an uncommon presentation of Treponema pallidum infection
Summary
We conducted a retrospective study to review the clinical profiles and visual outcomes of 10 patients (presenting symptoms in 13 eyes) with ocular syphilis treated at the Hospital Universiti Sains Malaysia from January 2013 to June 2017. We selected patients diagnosed with ocular syphilis based on history, clinical evidence of ocular inflammation not attributable to any other cause, and positive serology for Treponema pallidum. Serological tests include rapid plasma reagin (RPR), fluorescent treponemal antibody absorption (FTA-ABS), T. pallidum particle agglutination (TP-PA), and electrochemiluminescence immunoassay (ECLIA) for syphilis. Patients presumed to have ocular syphilis were investigated to exclude other possible causes of ocular infection, such as tuberculosis, toxoplasmosis, herpes simplex virus (HSV), and cytomegalovirus (CMV) and HIV. Cerebrospinal fluid (CSF) analysis was requested from our patients but none of them consented for the procedure
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