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Thomas Kandl, Ronald J Rescigno, David S Chu; A Resurgence in Ocular Syphilis: A Case Series. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3134.
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© ARVO (1962-2015); The Authors (2016-present)
According to the CDC, the rate of syphilis reported in the United States decreased through the 1990’s,was at its lowest ever reported in 2000, and then increased from 2001-2009. We presented a series at ARVO in 2000 highlighting the relatively high incidence of ocular syphilis seen at our institution during the 1990’s. This was followed by a lack of cases encountered between 2000 and 2013. However, 4 new cases of ocular syphilis have presented to our facility over the past year. We present these 4 cases and examine the potential implications in the recent rise in case volume.
To do a retrospective analysis of the patients at our institution with ocular syphilis from 2013-2014
All four of our patients presented with complaints of decreased vision and had clinical findings consistent with panuveitis with optic nerve involvement. One of the four patients was HIV positive and was diagnosed with AIDS, not undergoing treatment at the time of diagnosis. One patient was initially treated with oral corticosteroids for presumed sarcoidosis resulting in a significant worsening of symptoms and visual acuity prior to treatment for tertiary syphilis. One patient received local administration of corticosteroid for panuveitis by a private ophthalmologist prior to presenting to our facility. All four patients underwent thorough systemic work up with an Infectious Disease consult. All four patients responded to appropriate treatment with penicillin with improvement in clinical findings and visual acuity. Two of the patient’s final visual acuity returned to normal in both eyes. Two patient’s visual acuity returned to normal in one of the eyes with only mild improvement in the other eye.
Ocular syphilis often takes several years to manifest after initial infection. The case volume of ocular syphilis at our institution parallels national trends of syphilis infection. The paucity of cases during the early 2000’s corresponds with a decline in syphilis cases during the 1990’s, and the rise in ocular cases over the past year corresponds with the increasing rate of syphilis encountered from 2001-2009. We predict a rise in ocular syphilis cases, and though still a relatively rare entity, syphilis should remain high on the differential diagnosis when encountering a patient with severe uveitis as prompt diagnosis and treatment can avoid preventable, permanent visual loss.
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