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E.F. Hall, B. Snyers, M.W. Johnson; Ocular Syphilis Presenting as Pericentral Retinitis Pigmentosa . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1062.
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We report two cases of ocular syphilis presenting with a previously undescribed clinical appearance mimicking pericentral retinitis pigmentosa.
We reviewed the medical records of two patients and obtained information regarding presenting complaint, medical, ocular, family, and social history, review of systems, ophthalmic examination, ancillary testing, laboratory evaluation, treatment, and follow–up.
One patient was a 57–year old black male and the other a 56–year old white male. Both patients presented with gradual, progressive blurring of vision OU. One patient noted associated paracentral photopsias but neither had nyctalopia or hemeralopia. Neither patient had a significant medical, ocular or family history. Social histories revealed promiscuity. Reviews of systems were notable for night sweats and general fatigue. Presenting visual acuities were 20/25 OU and 20/60 OU. Slit–lamp examination revealed mild cells in the anterior chamber and vitreous OU in both patients. In the former patient, fundus examination showed waxy pallor of the optic discs, chorioretinal atrophy with pigmentary changes confined to the posterior pole and attenuation of vessels OU. In the latter patient, fundus examination showed panuveitis with cystoid macular edema OU. Over 16 years of follow–up the fundus appearance evolved to become similar to that of the first patient OU. In both patients, fluorescein angiography revealed late staining without evidence of vasculitis or leakage OU. Humphrey visual fields showed pericentral ring scotomas OU.
Laboratory evaluation was notable for a highly positive FTA–ABS, an RPR of 1:128, and VDRL 1:8 in one patient and a VDRL of 1:64, IF IgG 1:800, and TPHA 1:2680 in the other. HIV was negative in both patients. One patient was treated daily with 24 million units of intravenous penicillin for 10 days and then was lost to follow–up. The second patient was treated daily with 18 million units of intravenous penicillin for 12 days and was followed over 16 years. The ERG eventually became extinguished OU and his vision deteriorated to 20/200 OD and 20/400 OS.
Ocular syphilis presents with a variety of clinical manifestations. These two cases demonstrate an unusual and previously undescribed clinical presentation of ocular syphilis and suggest that syphilitic retinitis should be included in the differential diagnosis of pericentral retinitis pigmentosa.
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