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Andrew Pittner, Pauline Merrill, Palak Patel; Undiagnosed Ocular Syphilis Treated with Biologic Immunosuppressive Therapy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):872.
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We report three patients who presented as referrals for second opinions of chronic uveitis while being treated with a biologic immunosuppressive therapy, such as adalimumab and infliximab, and were then found to have positive syphilis titers. This retrospective case series illustrates the importance of diagnosis and treatment of ocular syphilis in patients being treated with a biologic immunosuppressive.
Retrospective case series (2016-2018) of three patients with undiagnosed ocular syphilis being treated with a biologic immunosuppressive at a Chicago area retina practice and an academic eye center.
Two cases were identified of misdiagnosed ocular syphilis in patients initially treated with adalimumab for their uveitis. There was a third case in a patient being treated with infliximab for ankylosing spondylitis who then presented with uveitis, and was found to have ocular syphilis. After positive treponemal (fluorescent treponemal antibody absorption; FTA-ABSs) and non-treponemal (rapid plasma regain; RPR) testing, the biologic immunosuppressive was stopped; signs of inflammation and visual acuity gradually improved with adequate treatment for neurosyphilis with intravenous penicillin in all three patients.
It is critical that syphilis is screened for in patients starting biologic immunosuppressive treatment for uveitis and in patients developing uveitis while on a biologic immunosuppressive, so as to ensure prompt and appropriate treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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