Ocular Syphilis: Staring Straight at You (P01.122)

Abstract

Objective: Syphilis is known as the great 9imitator9 of a myriad of presenting symptoms. This case presentation highlights the difficulty of diagnosing syphilis in the setting of unilateral photophobia. A 54 year old heterosexual male presented with a four month history of progressive left eye photophobia. He denied diplopia or visual field defects. Four months prior, he was treated with topical and oral steroids for inflammatory keratitis with relief; however, photophobia was exacerbated with steroid taper. He served in the Korean War during which he had multiple female sexual partners and did not use barrier contraception. Currently, he is in a four-year monogamous heterosexual relationship. Vital signs stable. Patient is alert and oriented with visual acuity of the right eye 20/20 and left eye 20/400. Fundoscopic exam of the left eye showed interior endothelial keratic precipitates. Neurological exam was unremarkable. Rapid plasma reagin was negative; however, fluorescent treponemal antibody absorption and treponema pallidum hemagglutination were both positive. Lumbar puncture revealed positive CSF RPR and FTA-MB, confirming our suspicion for neurosyphilis. Serology for HIV and assays for the detection of fungal antigen gave negative results. Patient was treated with IV penicillin G 24 million units daily for 14 days. At four month follow up his visual acuity improved and the uveoscleritis had resolved. A re-emergence of syphilis has been reported in the United States and Europe. This case demonstrates that the eye may be one of the numerous sites of syphilitic inflammation and damage. Secondary syphilis caused a progressive deterioration of ocular findings in our patient. This condition may result in permanent loss of vision if not adequately treated. In conclusion, ocular involvement should be carefully evaluated in patients with syphilis, and, at the same time, this infection should be considered as a potential cause of ocular inflammation. Disclosure: Dr. Faridani has nothing to disclose. Dr. Moore has nothing to disclose.