An upsetting asymmetric syphilitic uveitis : watch out for a second train
Purpose
Over the last decade, the prevalence of syphilis and its related complications has significantly increased. We aimed to report a case of syphilis with diverse and asymetric ocular manifestations in an immunocompetent patient.
Methods
Case report.
Results
A 40-year-old male presented with a one-week history of pain and blurred vision on the right eye. Visual acuity (VA) was hand motion. Ocular examination found a panuveitis with iris vascular engorgement, an hyphema and fundus bad visualisation. Ophtalmologic examination of the left eye was normal. The anamnesis found neither uveitis risk factors nor sexual risky behaviour. The etiological study revealed the diagnosis of syphilis, the brain MRI and CSF analysis reported a lymphocytic meningitis. A course of intravenous penicillin and local steroids was initiated, which decreased the vitritis, allowed us to observe the retina and thus perform further imaging tests. OCT, fundus autofluorescence and fluorescein angiography demonstrated a bilateral acute syphilitic posterior placoid chorioretinitis with papillitis, and on the right eye, a diffuse vasculitis with a superotemporal branch artery occlusion. Improvement of VA was rapidly obtained under treatment.
Conclusion
We present a case of syphilis with a wide range of ocular manifestations well-documented by multimodal imaging. It is an original case with monocular symptoms despite the bilateral involvement. This shows the importance and diagnostic help of a good examination of the asymptomatic eye in cases of ocular inflammation. It also highlights the relevance of a routine screening for syphilis, due to its clinical pleomorphism and potential aggressiveness, but reversibility with prompt treatment.
Conflict of interest
No
Authors 1
Last name
MAESTRI
Initials of first name(s)
F
Department
Ophtalmologie, Pitié Salpêtrière
City
Paris
Country
France
Authors 2
Last name
GOUNOU MOTCHOFO
Initials of first name(s)
A
Department
Ophtalmologie, Pitié Salpêtrière
City
Paris
Country
France
Authors 3
Last name
XAVIER
Initials of first name(s)
C
Department
Ophtalmologie, Pitié Salpêtrière
City
Paris
Country
France
Authors 4
Last name
BODAGHI
Initials of first name(s)
B
Department
Ophtalmologie, Pitié Salpêtrière
City
Paris
Country
France
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