Unilateral neuroretinitis as manifestation of syphilitic disease

Abstract

AbstractPurpose: Syphilis is a systemic sexually transmitted disease caused by the spirochete Treponema Pallidum. Ocular symptoms indicate neurological compromise, corresponding to 5%–8% of syphilis cases. The clinic is varied and involvement of practically any of the ocular structures has been described. The most frequent presentation is uveitis, which can be posterior, intermediate, anterior or panuveitis, unilateral or bilateral, granulomatous or not. It is responsible for 1%–2% of uveitis cases. This clinical experience aims to reinforce the existence of this entity and the importance of early treatment and adequate control of symptoms.Methods: A 35‐year‐old man presented blurred vision in the left eye of sudden onset of 2 days of evolution. On examination, visual acuity of right eye 1.0 and left eye 0.05 according to decimal scale. Biomicroscopy shows Tyndall, without retrokeratic precipitates or synechiae. Transparent cornea and isochoric normoreactive pupils. The eye fundus shows obliterated papillae with fibrinoid‐like material, vasculitis, scattered haemorrhages and macular folds. Right eye without alterations. He reports the possibility of a risky sexual relationship. In serological tests, IgM for Syphilis is detected. He is admitted to the Infectious Diseases service for intravenous treatment with Benzylpenicillin 4 million Ul/ 4H.Results: One month later, inflammation of the anterior pole has disappeared, but the fundus shows persistent neuroretinitis with edema of the optic nerve, macular star exudates and a focus of vasculitis in the superior temporal artery. Ozurdex is indicated. One month later, he shows visual acuity of 1 in left eye, and reduced inflammation of the optic nerve, exudates and haemorrhages.Conclusions: Ocular syphilis is an entity that is still present, as well as the importance of actively searching for it. It is a potentially serious disease that affects young adults, with a good response to treatment if the diagnosis is made early.