Abstract
BackgroundSyphilis is a reemerging sexually transmitted disease that can lead to any type of intraocular inflammation. Prognosis of syphilitic uveitis after appropriate therapy is classically regarded as favorable. However, visual threatening complications may develop, rarely including rhegmatogenous/tractional retinal detachment (R/T RD) and proliferative vitreoretinopathy.FindingsWe report 4 patients presenting with complex R/T RD and fulminant proliferative vitreoretinopathy despite treatment among 19 patients with syphilitic posterior uveitis consecutively seen at our uveitis service. Most of these complications occurred during or shortly after antibiotic therapy. All patients presented with significant intraocular inflammation, including vitritis, occlusive retinal vasculitis, and retinal infiltrates (necrotizing retinochoroiditis in six eyes of four patients). Two patients (50 %) tested HIV positive, and the same proportion had inadvertently received high dose oral ± intravenous corticosteroids prior to diagnosis of syphilis. Two patients (three eyes) underwent RD surgical repair. Histopathology of an excised epiretinal membrane disclosed fibroglial tissue, with immature glial cells and metaplastic retinal pigment epithelium, admixed with lymphoplasmacytic infiltrate.ConclusionsSyphilitic uveitis may be complicated by complex RD/fulminant fibroglial proliferation, occurring during/after treatment. Predisposing factors are currently unknown but may include prior use of corticosteroid, necrotizing retinitis and/or high spirochaetal load. A significant inflammatory component may underlie this fulminant fibroglial proliferation, being possibly amenable to modulation by aggressive anti-inflammatory therapy delivered concurrently with parenteral antibiotics.
Highlights
Syphilis is a reemerging sexually transmitted disease that can lead to any type of intraocular inflammation
Syphilitic uveitis may be complicated by complex rhegmatogenous/tractional retinal detachment (RD)/fulminant fibroglial proliferation, occurring during/after treatment
A significant inflammatory component may underlie this fulminant fibroglial proliferation, being possibly amenable to modulation by aggressive anti-inflammatory therapy delivered concurrently with parenteral antibiotics
Summary
Syphilis is a reemerging sexually transmitted disease that can lead to any type of intraocular inflammation. From April 2011 to October 2012, we had 19 consecutive patients with syphilitic posterior uveitis admitted to our referral hospital, of which 4 (21.05 %) presented with rhegmatogenous/tractional retinal detachment (R/T RD) and fulminant proliferative vitreoretinopathy (PVR) during or shortly after parenteral penicillin therapy. BCVA best corrected visual acuity, OD right eye, OS left eye, HM hand movements, VDRL Venereal Disease Research Laboratory, TPHA Treponema pallidum hemagglutination assay, CSF cerebrospinal fluid, HIV human immunodeficiency virus, PRI punctate inner retinal infiltrates, NRC necrotizing retinochoroiditis, RD retinal detachment CF, counting fingers, LP light perception PPCR, posterior placoid chorioretinitis, NPL no light perception aThe time indicated in brackets refers to interval between initial diagnosis and moment that the complication occurred / was detected.
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