September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Syphilitic Uveitis in Orange County, California, 2015: A Case Series
Author Affiliations & Notes
  • Doran Spencer
    Ophthalmology, UC Irvine, Orange, California, United States
  • Christopher Ried
    Orange County Health Care Agency, Santa Ana, California, United States
  • Ashkan Pirouz
    Retinal Consultants of Orange County, Fullerton, California, United States
  • Ansom Lam
    St Jude Medical Center, Fullerton, California, United States
  • Stephanie Lu
    Ophthalmology, UC Irvine, Orange, California, United States
  • Mitul Mehta
    Ophthalmology, UC Irvine, Orange, California, United States
  • Footnotes
    Commercial Relationships   Doran Spencer, None; Christopher Ried, None; Ashkan Pirouz, None; Ansom Lam, None; Stephanie Lu, None; Mitul Mehta, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4135. doi:
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      Doran Spencer, Christopher Ried, Ashkan Pirouz, Ansom Lam, Stephanie Lu, Mitul Mehta; Syphilitic Uveitis in Orange County, California, 2015: A Case Series. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4135.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To describe the clinical and epidemiological details of a case series of syphilitic uveitis in Orange County, California in the setting of an outbreak of a presumed eye- and neurotropic strain of syphilis on the U.S. West Coast in 2015.

Methods : The clinical and demographic characteristics of eleven patients are detailed starting with their initial diagnosis, including: age, gender, social/sexual history, HIV/RPR serology, complete physical exam including ophthalmic exam, ocular imaging studies, hematologic and chemistry results, LP/CSF examination, ancillary tests, treatment and subsequent clinical course. Some records are presently incomplete and undergoing review.

Results : All eleven patients were male, ages 24-63, 5/8 MSM, 5/10 HIV+ (4 newly diagnosed), presenting with uveitis ranging from subclinical to bilateral panuveitis. VA was 20/20 to HM. 5/6 had known prior RPR positivity and 3/6 had received recent IM (< 3m) treatment. 4/6 had vitritis, 1/6 had retinal findings (posterior placoid chorioretinitis). 3/6 had positive CSF findings. All patients received 2 weeks of IV Penicillin and 5/5 with follow-up experienced improvement in their symptoms and clinical exam. Further results are forthcoming pending additional chart review.

Conclusions : We have detailed the clinical characteristics of eleven patients with syphilitic uveitis, 5/10 of whom exhibited an atypical presentation in that ocular involvement occurred in early stages of their syphilitic disease; co-infection with HIV likely played a role in 5/10 patients. All patients with adequate follow-up responded well to conventional treatment for neurosyphilis. These findings are significant for demonstrating to ophthalmologists and the greater medical community the atypical course of ocular syphilis during the current outbreak and the possibility of a circulating eye- and neurotropic strain that leads to uveitis early in the disease process in immunocompromised and immunocompetent individuals. Recommendations regarding the benefit of close observation, early diagnosis and treatment in susceptible individuals, as well as the laboratory handling of clinical specimens to facilitate identification of high-risk T. pallidum strains for neurosyphilis are also discussed.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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