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Harrish Nithianandan, Jennifer Gao, Michael Dollin, Chloe Gottlieb; Syphilitic Uveitis as the Presenting Manifestation of Syphilis at a Canadian Tertiary Care Centre. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4186. doi: https://doi.org/.
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To date, there have been limited reports of ocular syphilis presenting at a Canadian tertiary centre. A retrospective observational case series was conducted to assess the clinical course of patients with syphilis initially manifesting as ocular inflammation.
Adult patients who presented to the University of Ottawa Eye Institute between September 2013 and January 10, 2017 with uveitic signs and symptoms and later serologically diagnosed with ocular syphilis were included in this study. Patients with a previous known history of syphilis were excluded. Patient demographics and clinical parameters were retrieved via chart review. Syphilis was diagnosed if IgG/IgM antibodies were detected via a chemiluminescence immunoassay, rapid plasma reagin titers were reactive and if T pallidum particle agglutination was positive. This study received ethics approval from the Ottawa Health Science Network Research Ethics Board.
Eleven males and 1 female (mean age: 59.1±11.5 years) were included in the analysis. Four of the 12 patients had HIV co-infection. There was bilateral ocular involvement in two patients. The most common presenting symptoms were decline in vision (12/12 patients), ocular pain (4/12), photophobia (4/12), and eye redness (3/12). The presenting mean logMAR BCVA and IOP were 1.43±0.9 and 15.2±3.0 mmHg, respectively in the more affected eye. An afferent pupillary defect was noted in 3 patients. Examination identified severe anterior uveitis in one patient, intermediate uveitis in 5 patients, posterior uveitis in 4 patients and panuveitis in 2 patients. Involvement of the optic nerve was appreciated in 3 patients. The median time from presentation to Penicillin therapy was 14.5 days (Range:1-73 days). Follow-up information was available for 9 patients. The median length of follow-up was 123 days. All eyes showed visual improvement post-treatment and the mean logMAR BCVA at final follow-up was 0.213±0.3. All eyes but one achieved a BCVA of 20/30 or better. All eyes showed resolution of uveitis and no evidence of inflammation at final follow-up.
Ocular syphilis as a first presentation of infection occurred predominantly in older males, above the age of 50 years. Although the presentation of ocular syphilis can be quite variable, a low clinical threshold for serologic testing and prompt antibiotic therapy are critical for clinical resolution of the infection.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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