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Margaret McDougal Runner, Brian C Toy, Andrew A Moshfeghi, Hossein Ameri, Narsing A Rao; Concurrent Acute Retinal Necrosis and Ocular Syphilis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1440.
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Independent from one another, both acute retinal necrosis (ARN) and ocular syphilis are rare ocular infections that can present in healthy individuals as well as immunocompromised patients. To our knowledge, ARN with concurrent ocular neurosyphilis has not been reported. Herein, we describe a case of a male with newly diagnosis human immunodeficiency virus (HIV) present with ARN from herpes simplex virus-1 (HSV1) with a second co-infection of ocular syphilis.
A detailed retrospective review was conducted of a case who presented in Los Angeles County, USA with ARN confirmed with positive ocular fluid HSV1 polymerase chain reaction (PCR) and co-infection of ocular syphilis confirmed with positive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) antibody and serum fluorescent treponemal antibody absorption (FTA-ABS).
A 54-year-old previously healthy male with a gradual three month decline in vision of the left eye, presented with acute painless vision loss of the right eye. On exam, the right eye had count fingers vision with active anterior chamber inflammation, dense vitritis, and a well-demarcated wedge-shaped peripheral chorioretinal lesion. Left eye was light perception vision with a quiet anterior chamber but with heterochromia of the iris and dense white uveitic cataract obscuring the view to posterior pole but ultrasound confirmed dense vitritis. Laboratory workup revealed a new diagnosis of HIV-1 and neurosyphilis confirmed with positive VDRL of the CSF. Anterior chamber fluid of the right eye was HSV1 positive, whereas anterior and vitreal samples of the left eye were HSV1 negative. The patient underwent a series of intravitreal foscarnet injections of the right eye and oral valacyclovir and two-week course of intravenous penicillin. The vitritis and vision improved in both eyes with the right eye recovering back to 20/40 vision.
Though a rare infection, the rate of ocular syphilis continues to rise especially in the Los Angeles County health network. Over the past five years the Los Angeles County ophthalmology service has treated roughly 55 patients with ocular syphilis, and as far as the authors are aware, this is the first case of ocular syphilis with a co-infection of viral acute retinal necrosis. Given the rise in these ocular infections, it is important to recognize and effectively treat the various clinical presentations of infectious panuveitis.
This is a 2021 ARVO Annual Meeting abstract.
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