Clinical Spectrum of Ocular Syphilis: Insights from a Single-center Case Series
Avani Bhadang1, Cassity High1, Soumya Shrigiri1, Harshita Cherukuri2, Nakul Katyal1
1University of Kentucky, 2Apollo Institute of Medical Sciences and Research, Hyderabad, India
Objective:
To highlight the spectrum of ocular manifestations associated with syphilis
Background:
Ocular syphilis accounts for approximately 1% of all syphilis cases in the United States, frequently occurs in the absence of systemic symptoms, and has the potential to involve nearly any ocular structure.
Design/Methods:
Case series
Results:
Six patients (2 males and 4 females) with a mean age of 51.3 years at diagnosis were identified with ocular syphilis. The diagnosis was confirmed in all cases by positive treponemal antibody tests, with one patient also showing a positive cerebrospinal fluid (CSF) VDRL. All patients presented with blurry vision and visual field defects (n=6), while additional symptoms included photophobia (n=1), red eye (n=1), and black spots in the visual field (n=1). Ocular involvement was bilateral in three cases. Clinical findings included uveitis in three patients, and one case each of neuroretinitis, episcleritis, and optic disc edema.
Predisposing factors included HIV status (n=1), Men who have sex with men (MSM) (n=2). All patients were treated with 14 days of intravenous penicillin therapy. 1 patient underwent a penicillin desensitization protocol.
Conclusions:
The diverse patterns of eye structure involvement, absence of systemic manifestations, and wide range of ocular symptoms observed in our case series underscore some of the most challenging aspects of ocular syphilis.
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