Search

Introduction: Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis occurs only in 0.6 percent of patients. A resurgence of syphilis cases has been observed for several years in many countries, especially in HIV-infected subjects. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis., Case Reports: We report 2 patients with syphilitic uveitis diagnosed and treated at the department of infectious diseases at the University hospital of Marrakech. Ocular involvement was inaugural in both HIV patients. Each had a specific treatment, but none had a complete recovery of visual function; the first patient was treated by ceftriaxone and the second one was treated by penicillin., Conclusion: Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Although not evidence-based, prompt therapy may lead to functional recovery. Ceftriaxone could be a suitable alternative to penicillin in the treatment of early syphilis in HIV-infected patients. This treatment has a concomitant effectiveness even for asymptomatic forms of neurosyphilis. Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection.Conventional syphilis staging is of little use in understanding ocular syphilis. Co-infection between HIV and ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term., (Copyright © 2022 SFMTSI.)

In a patient with sub-acute loss of vision a panuveitis with papillitis and chorioretinitis was diagnosed within an initial diagnosis of lues and human immunodeficiency virus (HIV). Epidemiological data show an increasing incidence of HIV and lues infections in recent years. Therefore, ophthalmologists need to bear an infectious etiology of inflammation of the eye in mind.

SERIAL CASE REPORTS OF THREE MEN WITH PAPILLEDEMA AND VISUAL LOSS: The patients developed primarily visual loss on one or both sides with angiographically and clinically diagnosed papilledema. The neurological and internistic examinations were unsuspicious; however, serology ultimately confirmed the suspected papillitis in acute syphilis., Conclusion: Papillitis with visual loss can be a symptom of syphilis. Not only the known placoid chorioretinitis syphilis has to be considered but also a detailed medical history and diagnostic measures are essential to determine the cause. The guiding principle is usually also the relatively young age of the patients, male gender, sexual orientation and the lack of classic risk factors for anterior ischemic optic neuropathy (AION) or neurological causes of blurred edge swollen papilla as an intracranial mass lesion (papilledema).

Background: The clinical polymorphism of syphilis leads to diagnostic issues. We report a case of secondary syphilis revealed by skin and mucosal erosions, and responsible for sensorineural hearing loss and asymptomatic papillitis., Patients and Methods: A 55-year-old man presented oral and peri-anal erosions as the initial symptoms of secondary syphilis. He reported hypoacusis and a pure-tone audiogram revealed bilateral sensorineural hearing loss. Ophthalmological investigation revealed isolated right papillitis and superior temporal scotoma with blind-spot enlargement. TPHA-VDRL serology was strongly positive for plasma (TPHA 1/10,240 and VDRL 1/64) but doubtful for cerebrospinal fluid. For his hearing and eye disorders, considered as related to neurosyphilis, the patient received a 14-day course of intravenous penicillin G, associated with systemic corticosteroids with gradual reduction over a period of fifteen weeks. The patient's skin and mucosal erosions resolved, as did his papillitis. His hearing loss remained stable. Serological monitoring at three months showed a sixteen-fold decrease in VDRL titre., Discussion: The re-emergence of syphilis has led to increasing incidence of related ophthalmological and otological disorders. This report highlights the first-line role of the dermatologist in systematic diagnosis and in screening for associated involvement., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: Syphilis may manifest as several distinct ophthalmological forms. The main objective of our study was to describe the diagnostic, therapeutic data and prognosis of ocular syphilis., Patients and Methods: We retrospectively analysed the cases of syphilitic uveitis diagnosed in the University Hospital of Nantes between 2000 and 2013., Results: Twenty-seven patients were included in our study. Their mean age was 53.1 years. Bilateral uveitis was the most frequent clinical presentation (67%). The average diagnostic delay after the first symptoms was 2.8 months. Three patients (11%) presented with an anterior uveitis and 24 (89%) with a posterior uveitis, panuveitis or papillitis. The most frequent clinical signs were papillar lesion (44%), multifocal choroiditis (33%) and chorio-retinitis (37%). Ninety-three percent of the patients were treated with benzathine penicillin intravenously, one patient was treated by intramuscular penicillin injections and another by ceftriaxone intramuscularly. Ocular manifestations alone were sufficient to make the diagnosis of syphilis in 25 patients (93%) and of HIV seroconversion in 3 patients (11%). Forty-one percent of the patients benefited from an adjuvant therapy with corticosteroids. The treatment allowed a visual improvement of -0.48 log MAR (P<0.0001) with an average reduction of retinal central thickness of 70.2 μm (P=0.33)., Conclusion: We did not find a significant difference neither in management nor in results between the HIV seropositive and HIV seronegative groups. Others studies remains controversial about this aspect. The increased frequency of ocular manifestation as well as the increase of syphilis makes systematic screening in uveitis of a great value., (Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Purpose: To report a patient previously treated for primary and secondary syphilis who presented with papillitis. The patient was found to have neurosyphilis likely due to inadequate treatment of primary and secondary syphilis. Observations: A 60-year-old male with human immunodeficiency virus (HIV) and hepatitis C was referred for evaluation of blurry vision for the past several months. Anterior segment examination was notable for 1+ diffuse non-granulomatous keratic precipitates and 2+ flare with trace cell in both eyes. Dilated fundus exam revealed grade 2 optic disc edema in both eyes with no evidence of infectious retinitis. He was recently treated for syphilis with a single dose of intramuscular (IM) penicillin. These findings were consistent with syphilitic papillitis likely secondary to neurosyphilis. The patient underwent a lumbar puncture which confirmed the diagnosis of neurosyphilis. He was admitted to the hospital for intravenous (IV) penicillin. He later revealed a prior history of syphilis that was treated 3 years ago and 1 year ago. Conclusions and importance: Ocular syphilis can have a wide variety of presentations. Any patient with syphilis and uveitis should have prompt work up for neurosyphilis. Patients with any stage of syphilis need close follow up with repeat titers after treatment to ensure adequate treatment and prevent progression and permanent ocular or neurologic sequelae.

Syphilis produces myriad nonspecific signs and symptoms. For example, optic disk swelling might be seen in patients with syphilis as a result of cranial hypertension (papilloedema), inflammatory optic neuritis with papillitis, or optic perineuritis. We report a case involving differential diagnosis of syphilitic bilateral papillitis mimicking papilloedema.

Patients with syphilis can present with optic disc oedema (ODE) without visual compromise, which has been primarily attributed to papilloedema from raised intracranial pressure or optic perineuritis from optic nerve sheath inflammation. We report four cases of ODE in the setting of syphilis with preserved visual function, normal intracranial pressure, and no enhancement of the optic nerve or sheath on magnetic resonance imaging. We propose the term "incipient syphilitic papillitis" for cases presenting with ODE, preserved vision and absence of optic nerve sheath enhancement, which is likely a more common presentation than syphilitic optic perineuritis. [ABSTRACT FROM AUTHOR]

A 27-year-old male was presented with a decrease in vision in the left eye. Best-corrected visual acuity was 10/10 in the right eye and counting fingers at 2 m in the left eye. On fundus examination, the left optic disc was oedematous and there was a wide yellowish, well-defined placoid lesion between the temporal vascular arcades with mild vitreous inflammation. However, a small yellowish well-defined placoid lesion was detected in the inferior temporal region of the macula in the right eye. He was diagnosed with posterior placoid chorioretinopathy (PPC), papillitis, and neurosyphilis after performing fundus fluorescein angiography, fundus autofluorescence imaging, optical coherence tomography, serology for human immunodeficiency virus (HIV) and syphilis, and cerebrospinal fluid examination. Intravenous penicillin treatment was commenced as soon as the diagnosis was established. Seven days after treatment initiation, lesions were partially regressed. PPC and papillitis are rare manifestations of ocular syphilis. In addition, neurosyphilis may also accompany these manifestations. Therefore, syphilis should be considered in the differential diagnosis of patients who have PPC or papillitis and all patients should be tested for HIV coinfection and neurosyphilis. [ABSTRACT FROM AUTHOR]

Syphilis produces myriad nonspecific signs and symptoms. For example, optic disk swelling might be seen in patients with syphilis as a result of cranial hypertension (papilloedema), inflammatory optic neuritis with papillitis, or optic perineuritis. We report a case involving differential diagnosis of syphilitic bilateral papillitis mimicking papilloedema. [ABSTRACT FROM AUTHOR]

Résumé Introduction La syphilis peut se présenter sous de nombreuses formes ophtalmologiques. L’objectif principal de notre étude était de préciser les éléments diagnostiques, thérapeutiques et pronostiques des cas de syphilis oculaire. Patients et méthodes Nous avons analysé rétrospectivement les cas d’uvéites syphilitiques vues au CHU de Nantes de 2000 à 2013. Résultats Vingt-sept patients ont été inclus avec une moyenne d’âge de 53,1 ans. L’uvéite était plus fréquemment bilatérale (67 %). Le délai moyen du diagnostic après les premiers symptômes était de 2,8 mois. Trois patients présentaient une uvéite antérieure (11 %) et 24 une atteinte postérieure, panuvéite ou papillite (89 %). Les présentations cliniques les plus fréquemment observées étaient l’atteinte papillaire (44 %), la choroïdite multifocale (33 %) ou un foyer chorio-rétinien (37 %). Quatre-vingt-treize pour cent des patients ont bénéficié d’un traitement par benzathine pénicilline en intraveineux, un patient a été traité par injections intramusculaires et un autre patient par ceftriaxone intramusculaire. L’atteinte oculaire a permis de faire le diagnostic de syphilis dans 25 cas (93 %) et de séropositivité VIH chez 3 patients (11 %). Quarante et un pour cent des patients ont bénéficié d’un traitement adjuvant par corticoïdes. Le traitement a ainsi permis une amélioration visuelle de –0,48 log MAR ( p < 0,0001) et une réduction moyenne de l’épaisseur centrale de la rétine de 70,2 μm ( p = 0,33). Conclusion Nous n’avons pas objectivé de différence significative de prise en charge ni de résultats entre le groupe VIH séropositif et séronégatif. Les autres études divergent à ce sujet. La fréquence de l’atteinte ophtalmologique et l’augmentation de l’incidence de cette pathologie montrent l’intérêt d’un dépistage systématique en cas d’uvéite. Introduction Syphilis may manifest as several distinct ophthalmological forms. The main objective of our study was to describe the diagnostic, therapeutic data and prognosis of ocular syphilis. Patients and methods We retrospectively analysed the cases of syphilitic uveitis diagnosed in the University Hospital of Nantes between 2000 and 2013. Results Twenty-seven patients were included in our study. Their mean age was 53.1 years. Bilateral uveitis was the most frequent clinical presentation (67%). The average diagnostic delay after the first symptoms was 2.8 months. Three patients (11%) presented with an anterior uveitis and 24 (89%) with a posterior uveitis, panuveitis or papillitis. The most frequent clinical signs were papillar lesion (44%), multifocal choroiditis (33%) and chorio-retinitis (37%). Ninety-three percent of the patients were treated with benzathine penicillin intravenously, one patient was treated by intramuscular penicillin injections and another by ceftriaxone intramuscularly. Ocular manifestations alone were sufficient to make the diagnosis of syphilis in 25 patients (93%) and of HIV seroconversion in 3 patients (11%). Forty-one percent of the patients benefited from an adjuvant therapy with corticosteroids. The treatment allowed a visual improvement of –0.48 log MAR ( P < 0.0001) with an average reduction of retinal central thickness of 70.2 μm ( P = 0.33). Conclusion We did not find a significant difference neither in management nor in results between the HIV seropositive and HIV seronegative groups. Others studies remains controversial about this aspect. The increased frequency of ocular manifestation as well as the increase of syphilis makes systematic screening in uveitis of a great value. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Whereas syphilis is a classical cause of uveitis, it is still often under-recognized. Treatment recommendations are not based on specific clinical studies. Case reports: We report two patients with syphilitic uveitis diagnosed and treated at the University Hospital of Angers. Ocular involvement was inaugural in both patients. Each had a specific treatment but none had a complete recovery of visual function. Conclusion: Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. Although not evidence-based, prompt therapy may lead to functional recovery. [Copyright &y& Elsevier]

Abstract Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.

Abstract: Objective: Syphilitic ocular manifestations are polymorphous and usually occur during the secondary or tertiary stage of syphilis. We report a case of primary syphilis revealed by papillitis. Design: A 22 year old man presented with blurred vision in the left eye and decreased visual acuity. Fundus examination and fluorescein angiography revealed a papilledema in the left eye and chorioretinitis in the right one. Clinical examination revealed a painless ulceration of the chin. Blood tests were positive for syphilis (positive reaction to the VDRL test and TPHA titer at 1/640) but negative for HIV. After penicillin therapy, the ocular manifestations resolved. Results: Papillitis is a relatively rare ocular manifestation of syphilis. Our case is original because papillitis was the presenting manifestation of the disease and that it was concomitant with the primary chancre. Conclusion: Systematic screening for syphilis should be performed in unexplained ocular inflammation. [Copyright &y& Elsevier]