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(searched for: Neurosyphilis Presenting with Optic Neuritis)
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S. C. Reddy, R. Arvinth, Z. Mimiwati
European Journal of Clinical Medicine, Volume 2, pp 1-3; https://doi.org/10.24018/clinicmed.2021.2.5.126

Abstract:
The incidence of syphilis has greatly reduced in the severity of affected individuals due to the early treatment with antibiotics. However, due to the increase in the prevalence of human immunodeficiency virus (HIV) infection, it has also caused a concurrent rise in the number of neurosyphilis patients. Most common ocular manifestations include uveitis, interstitial keratitis, and vasculitis. A healthy 28-years old man presented with a progressive blurring of vision in the right eye for one month. It was his second episode. The first episode occurred 4 months back which resolved spontaneously without treatment. Vision in the right eye was 6/18. The pupil was dilated and the relative afferent pupillary defect was positive. Fundus examination showed a hyperemic swollen right optic disc with blurred margins and no macular fan or star. Vision, anterior segment, and fundus were normal in the left eye. After the investigations, he was diagnosed as a case of neurosyphilis with optic neuritis. He was treated with intravenous penicillin for two weeks followed by oral penicillin for three weeks. Vision in the right eye improved to 6/6; the optic disc swelling resolved with clear margins. He maintained good vision during the follow-up of six months. Early referral to an ophthalmologist upon suspicion of syphilis, detailed evaluation, and immediate treatment is mandatory to prevent permanent vision loss in these patients.
Published: 28 July 2021
Abstract:
Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema pallidum. It can cross the blood-brain barrier within days of the infection, causing neurosyphilis and ocular syphilis at any stage of the disease. Ocular syphilis can manifest in any part of the eye but usually as posterior uveitis and pan-uveitis or various types of inflammatory or immune-mediated optic neuritis. Misdiagnosing ocular syphilis as a non-infectious disease has been reported even when seen by ophthalmologists due to the wide variety of possible presentations. In this case report, we describe a case of ocular syphilis that presented with a non-arteritic anterior ischemic optic neuropathy (NA-AION), which to our knowledge, has not been described before in the literature.
Tatiana Vaz Leite Pinto, Antônio Pereira Gomes Neto, Matheus Nader Cunha, Letícia Moreira Bernardino,
Published: 1 July 2021
by SciELO
Arquivos de Neuro-Psiquiatria, Volume 79, pp 584-589; https://doi.org/10.1590/0004-282x-anp-2020-0332

Abstract:
Background: In the era of the re-emergence of syphilis, ocular syphilis has gained attention because its prevalence has increased and it can cause blindness and disability. Objectives: To investigate the clinical presentation and prognosis of ocular syphilis. Methods: Prospective study on 53 patients (90 eyes) with ocular syphilis diagnosed at the Santa Casa of Belo Horizonte, Brazil. The diagnosis was based on clinical manifestations of the disease and on serological markers (positive serum treponemal and non-treponemal tests or two positive treponemal tests). Results: Thirty-five eyes (66%) were from men and the mean age was 45.3 ± 12.0 years. HIV coinfection was confirmed in 10 patients (18.9%). Forty-four (84.9%) had VDRL titers ≥ 1:32. Bilateral ocular involvement occurred in 68%. Optic neuritis was diagnosed in 51.7% of the eyes and uveitis in 48.2%. Regarding visual acuity, the median baseline logarithm of the minimum angle of resolution (logMAR) was 1 (20/200 Snellen), while after antibiotic therapy, the median was 0.2 (20/30 Snellen). Poor visual acuity after treatment, defined as the best-corrected visual acuity (BCVA; logMAR 1; 20/200 Snellen) or worse, was associated with severe BCVA at presentation (below logMAR 1.3; 20/400 Snellen) (p = 0.001) and age over 50 years (p = 0.001). Conclusions: This study confirms the wide spectrum of clinical manifestations of ocular syphilis. The most frequent form was optic neuritis, an important differential diagnosis from other causes of inflammatory neuritis. Early diagnosis is essential, given that this is a treatable condition with excellent visual recovery in most cases.
Murtaza S. Khan, Dulanji K. Kuruppu, Tanav A. Popli, Ramana S. Moorthy, Devin D. Mackay
RETINAL Cases & Brief Reports, Volume 14, pp 35-38; https://doi.org/10.1097/icb.0000000000000614

Abstract:
Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis. A case report of a 22-year-old man with progressive unilateral vision loss. With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin. This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.
, Omar Abdelmaksoud, Abdulmawla Albirini
Avicenna Journal of Medicine, Volume 10, pp 122-124; https://doi.org/10.4103/ajm.ajm_215_19

Abstract:
Onychoptosis is the periodic shedding and falling of one or more nails, in whole or part. It can be seen after fever, trauma, adverse reaction to medications, and in systemic illnesses including syphilis (syphilitic onychia). We report a case of 38-year-old man presented with subacute bilateral retrobulbar optic neuritis. Physical examination revealed diffuse onychoptosis which lead into the diagnosis of neurosyphilis. Symptoms significantly improved with appropriate treatment with intravenous penicillin G for 14 days.
Published: 5 February 2019
by Cureus
Abstract:
Introduction Ocular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia. Methodology This was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed. Results A total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes. Conclusions Posterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.
Jiang Zhu, Yuan Jiang, , Bo Zheng, Zhiguo Xu, Wei Jia
Abstract:
Syphilitic chorioretinitis should be included in differential diagnosis of any form of ocular inflammation. A significantly higher proportion of human immunodeficiency virus (HIV)-positive patients with ocular syphilis as compared to HIV-negative cases have been reported in published studies. However, the clinical signs and symptoms are more insidious in HIV-negative patients who are easily misdiagnosed. We report a series of cases of ocular syphilis and describe the clinical manifestations and treatment outcomes of syphilitic chorioretinitis in HIV-negative patients in China. This was a retrospective case series study. The clinical records of patients with syphilis chorioretinitis were reviewed. Demographic information and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. All patients received the standard treatment. Ophthalmology examination and laboratory evaluation were repeated every 3 months. All changes were recorded. The treatment was considered successful if the patients had no inflammation in both eyes and rapid plasma reagin titer was negative after therapy. The study examined 41 eyes of 28 HIV-negative patients. The main complaints were blurry vision, floaters, and visual field defect. Twenty-seven eyes presented with panuveitis, and all had posterior involvement, including uveitis, vasculitis, chorioretinitis, and optic neuritis. The most common manifestations were uveitis and retinal vasculitis. Disc hyperfluorescence and persistent dark spots were the most common findings on FFA and ICGA. The ill-defined inner segment/outer segment junction was the most frequent manifestation on SD-OCT. Patients were diagnosed with syphilitic uveitis based on positive serological tests. Best-corrected visual acuity (BCVA) was improved in 34 eyes after treatment. Eleven patients were misdiagnosed before serological tests were performed. The delay in treatment led to long-standing cystoid macular edema and optic neuropathy, which were associated with poor BCVA (P = .037). The common manifestations of syphilitic chorioretinitis were uveitis, retinal vasculitis, and optic neuritis. Further diagnosis should be prompted by FFA, ICGA, and SD-OCT when ocular manifestation is suspected. The standard treatment for neurosyphilis was effective. If patients are presumed to be in low-risk groups such as HIV-negative, delays in diagnosis, and therapy may be likely. It is necessary to reiterate the importance of including syphilis uveitis as a differential diagnosis for any form of ocular inflammations, especially posterior uveitis and optic neuropathy.
S S Cao, H Y Li, Q G Xu, , S H Wei
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology, Volume 52, pp 898-904

The publisher has not yet granted permission to display this abstract.
M Li, Q G Xu, J Q Wang, Y R Wang, J Zhao, S H Wei
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology, Volume 52, pp 911-917

The publisher has not yet granted permission to display this abstract.
Clare Wood, Jane Wells, Nick Jones, Ashish Sukthankar
Published: 30 June 2016
by BMJ
Sexually Transmitted Infections, Volume 92; https://doi.org/10.1136/sextrans-2016-052718.43

Abstract:
Background Ocular involvement of syphilis remains relatively rare, however our clinic has seen a recent flurry of cases with 13 new diagnoses in the last 2 years, compared with 11 seen in the proceeding 10 years. It can be difficult to diagnose with no pathognomonic signs and can affect any structure of the eye. Aim To present a cluster of 13 new cases ocular syphilis diagnosed from 2013 until January 2016. Methods A retrospective case review. Results In conjunction with our tertiary eye hospital, our clinic’saw 13 patients diagnosed with ocular syphilis between July 2013 and January 2016. All 13 patients were male: 6’heterosexual; 5 men who have sex with men (MSM) and 2 bisexual. 3 patients were HIV positive. Mean age 42 (range 22–75). Ocular involvement included uveitis (anterior, posterior and pan-), optic neuritis, papillitis and retinitis. Cases include both unilateral and bilateral symptoms. All were treated as per national guidelines for neurosyphilis with procaine penicillin plus probenecid, proceeded by oral steroids. The majority of these patients’ symptoms resolved following treatment, however a few continue to have ongoing visual disturbances. Discussion We present our 13 cases of ocular syphilis. They illustrate the diverse range of presentations of ocular syphilis and the importance of partnership between the GU clinic and specialist ophthalmology services.
, Lynn L. Huang, Daniel F. Rosberger
Journal of the National Medical Association, Volume 107, pp 130-132; https://doi.org/10.1016/s0027-9684(15)30037-7

The publisher has not yet granted permission to display this abstract.
A.-L. Cassilde, , S. Baccar,
European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 131, pp 389-391; https://doi.org/10.1016/j.anorl.2014.02.003

The publisher has not yet granted permission to display this abstract.
, Alisson Pittol Bresciani, Marcus Victor De Oliveira, Pedro Henrique De Campos Albino, Melina Moré Bertotti, Ana Magda Bruscato, Luiz Paulo Queiroz, Paulo Mattosinho-Filho
Published: 31 December 2012
Revista Neurociências, Volume 20, pp 546-551; https://doi.org/10.4181/rnc.2012.20.617.6p

Abstract:
Introduction. Neurosyphilis is an uncommon manifestation of cen­tral nervous system (CNS) infection caused by Treponema pallidum. Cases. We report three cases of neurosyphilis. Case 1 presented with ocular involvement: right optic atrophy and left optic neuritis; case 2 had a meningovascular form, with ischemic stroke; and case 3, a meningeal form, presented with headaches as the main complaint. Discussion. The cases reported had distinguished forms of neuro­syphilis. Serologic diagnosis depends on the presence of antibodies: Veneral Disease Research Laboratory (VDRL) - not specific – and/ or Fluorescent Treponemal Antibody Absorption (FTA-ABS) - spe­cific. Conclusion. In the cases above cerebrospinal fluid FTA-ABS was a diagnostic clue for neurosyphilis even though unreactive serum VDRL was found.
E M Draeger, Z K Durani, G Hitch, B T Goh
Published: 23 May 2012
by BMJ
Sexually Transmitted Infections, Volume 88; https://doi.org/10.1136/sextrans-2012-050601c.54

Abstract:
Background Ocular syphilis can affect most eye structures and can be the result of congenital and acquired infection. Many ocular signs are not specific to syphilis and it can be difficult to make the diagnosis. Aim This study aims to investigate the epidemiology of ocular syphilis presenting to an oculogenital clinic. Method Retrospective case notes review of ocular syphilis cases seen between 1965 and 2011. Of 307 cases with ocular signs and positive treponemal serology, 85 cases with a history of yaws were excluded, leaving 222. Results Of the 222 cases, 93 (42%) were late congenital (CS), and 129 (58%) were acquired (AS). Of the CS cases, the mean age was 47.5 (range 7–86), 37 (40%) were male, of whom 1 was MSM. 55 (59%) were from the UK, 19 (20%) from the Caribbean, 9 (10%) from Europe. Eye signs were as follows: interstitial keratitis 73, anterior uveitis 23, posterior uveitis 10, panuveitis 3, Argyll-Robertson pupils (ARP) 1 and optic neuritis (ON) 1. Of the AS cases, the mean age was 50.9 (range 17–85), 99 (77%) were male, of whom 15 were MSM. 31 (24%) were from the UK, 15 (12%) from Europe, 51 (40%) from the Caribbean and 16 (12%) from Africa. 17 (13%) were early syphilis (secondary/early latent) and 112 (87%) were late latent or tertiary syphilis. Eye signs were as follows: anterior uveitis 63, posterior uveitis 21, panuveitis 13, optic atrophy 9, ON 8 and ARP 5. 35 (38%) of CS cases and 8 (6%) of the AS cases had extra-ocular signs of syphilis. Treatment was with a neurosyphilis regimen. STI screen were offered to all patients. Concomitant STIs are shown in the abstract P54 table 1. Number of patients presenting with concomitant STIs Conclusions (1) Ocular syphilis has varied presentations. (2) Screening for other STIs is important even in late CS and AS. (3) Ocular syphilis can be the only sign of syphilis: clinicians should consider syphilis as a cause of undiagnosed eye signs.
I E Torshina, V V Mogilevtsev, A A Lugovaia
Published: 5 May 2011
Vestnik oftal'mologii, Volume 127

The publisher has not yet granted permission to display this abstract.
, S. Wiertlewski
Published: 31 July 2010
La Revue de Médecine Interne, Volume 31, pp 481-485; https://doi.org/10.1016/j.revmed.2009.03.372

The publisher has not yet granted permission to display this abstract.
, Alberto Primavera, Elisabetta Capello, , Giovanni Mazzarello, Claudio Viscoli, Angelo Schenone
The Italian Journal of Neurological Sciences, Volume 31, pp 365-367; https://doi.org/10.1007/s10072-010-0222-8

The publisher has not yet granted permission to display this abstract.
, Ivana Bednar, , Ivanka Petric-Vicković, Zdravko Mandić
Published: 1 June 2008
Acta Clinica Croatica, Volume 47

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Comment
Gregory P Van Stavern
Journal of Neuro-Ophthalmology, Volume 27, pp 330-331; https://doi.org/10.1097/01.wno.0000155606.09706.56

Abstract:
Chronic infections are notoriously difficult challenges for the clinician. With respect to determining their clinical spectra, diagnosing them, treating them, or studying their epidemiology, they are daunting. HIV, tuberculosis, syphilis, malaria, and Lyme disease, to name just a few, continue to vex us and make us humbler and wiser physicians. The study by Sibony et al in this issue of Journal of Neuro-Ophthalmology (citation here) is an effort to determine whether various forms of optic neuropathy are within the spectrum of Lyme disease. The authors used a retrospective chart review of patients within a patient database at SUNY Stony Brook School of Medicine; the school is located in an area endemic for Lyme disease. Out of 440 patients presenting with optic neuritis, the authors found that only five (1%) had compelling evidence that active Borrelia burgdorferi was responsible for, or contributed to, their visual deficit. This would indicate that in an academic center in an endemic area in the United States, extremely few patients with optic neuritis had Lyme disease as a cause, and that it is not a common cause of optic neuritis. Why did I include the qualifier “in the United States” in the aforementioned sentence? Because Lyme neuroborreliosis has different clinical phenotypes for different genotypes of infecting subtypes of B. burgdorferi spirochetes. This has been an observation in the human disease (1) and its animal models (2). Thus, the conclusions drawn from the study of Sibony et al may not be readily applicable to Lyme disease in Europe, where the disease has a more aggressive neurologic presentation (3). Not surprisingly, investigators in Europe such as the Finns (4) and the Germans (5), both appropriately quoted in the study of Sibony et al, might dispute the conclusion that optic neuritis is rare in Lyme neuroborreliosis. The difference is likely because of the fact that American neuroborreliosis is caused predominantly by B. burgdorferi sensu stricto, whereas European disease is caused by B. garinii or B. afzelii, and the genetic differences between these subspecies are considerable. Another issue that the authors did not address is the nagging question of whether our serological assays (enzyme-linked immunosorbent assay and Western blot) are so powerful that they will always be positive in cases of optic neuritis caused by B. burgdorferi. My answer is, possibly not! The concern is that in this chronic infection, it is conceivable that spirochetes can be cleared from the periphery but retained in “immune-privileged” sites such as the eye or the brain. Thus, an enzyme-linked immunosorbent assay-positive but Western blot-negative patient with optic neuritis could conceivably be infected yet have a localized process without adequate peripheral activation to become Western blot positive. A similar situation occurs in tertiary neurosyphilis, in which the CSF (cerebrospinal fluid) VDRL can be negative in a substantial percentage of cases despite a positive serum FTA-ABS. These remarks do not detract, of course, from a very nice contribution to the literature by Sibony et al, especially in pointing out that optic nerve involvement in Lyme borreliosis in the United States is predominantly found in the child with meningitis, increased intracranial pressure, and optic disc edema. Retrobulbar neuritis remains very unlikely to be caused by Lyme disease; most likely it has another cause.
Halim Fadil, Roger E. Kelley, Eduardo Gonzalez‐Toledo
International Review of Neurobiology, Volume 79, pp 393-422; https://doi.org/10.1016/s0074-7742(07)79018-9

The publisher has not yet granted permission to display this abstract.
Current HIV Research, Volume 3, pp 95-98; https://doi.org/10.2174/1570162052773031

Abstract:
The rate of syphilis/HIV co-infection amongst men who have sex with men (MSM) in large urban regions ranges from 20 to 70% (7). Concurrent HIV infection can alter the clinical presentation of syphilis, the response to treatment, and complicate the diagnosis and clinical course of neurosyphilis (18). Therefore whether to perform a lumbar puncture (LP) on every co-infected patient in order to diagnose neurosyphilis is controversial. Current clinical guidelines specify the indications for LP, but fall short of recommending LP in certain clinical situations such as early syphilis without neurological involvement. This article reviews the current literature on the relative utility and indications for LP in syphilis/HIV co-infected patients and new research in this area. SYPHILIS IN THE PRESENCE OF HIV INFECTION The clinical features of syphilis are altered by concomitant HIV infection. HIV co-infection is associated with multiple chancres in primary syphilis and multiple concomitant genital ulcers in secondary syphilis (33), increased frequency of acute syphilitic meningitis in early syphilis (18), high rapid plasma reagin (RPR) titres, rapid progression to tertiary disease, increased ocular disease (uveitis, keratitis, optic neuritis, conjunctivitis, optic atropy, chorioretinitis), delayed or failed normalisation of cerebrospinal fluid (CSF) markers after treatment, and predilection for the Jarisch-Herxheimer reaction (1, 6, 9, 13- 15, 17, 19, 21, 29, 32, 36). Further, syphilis can relapse following treatment in HIV-infected patients (1-3, 12, 13, 17, 19, 29, 30, 32, 35). The pathogenesis of these clinical features may be related to the incomplete clearance of the spirochete from the central nervous system (CNS) because of relative immunodeficiency (22, 30). Therefore, excluding neurosyphilis by CSF examination in co-infected patients becomes more important than in persons with syphilis alone. Syphilis and the CNS Before the advent of penicillin, examination of CSF by LP was performed routinely on patients with syphilis in order to determine the duration of heavy metal therapy (24). Studies from the early part of the century showed CSF abnormalities such as pleocytosis and raised protein concentration in as many as 70% of patients with early syphilis (11, 26, 27, 31, 37) and, importantly, that these findings were predictive of the development of symptomatic neurosyphilis (28). Treponema pallidum invades the CNS in approximately 25% of patients, irrespective of HIV sero-status (32). Neuroinvasion occurs during untreated early syphilis, thence T. pallidum either spontaneously clears from the CNS, persists (asymptomatic syphilitic meningitis) or progresses
R J Guiloff, S V Tan
Published: 1 April 1992
Bailliere's clinical neurology, Volume 1, pp 103-54

The publisher has not yet granted permission to display this abstract.
V Bouisse, I Cochereau-Massin, D Jobin, M Lautier-Frau, M Barry, P Le Hoang, F Rousselie
Published: 1 January 1991
Journal Français d'Ophtalmologie, Volume 14

The publisher has not yet granted permission to display this abstract.
G W Zaidman
Published: 1 September 1986
Annals of Ophthalmology, Volume 18, pp 260-1

The publisher has not yet granted permission to display this abstract.
Ronald L. Seeley, Manuel Sarkar, J. Lawton Smith
Archives of Ophthalmology, Volume 87, pp 16-20; https://doi.org/10.1001/archopht.1972.01000020018003

Abstract:
A comparative study of 105 patients with borderline serum fluorescent treponemal antibody absorption (FTA-ABS) test results and 50 patients with nonreactive serum FTA-ABS test results was performed. "Syphilitic pupils" were found in 4% of the patients with nonreactive FTA-ABS tests, but in 15% of the borderline group. Optic atrophy was found in 18% of the control group and in 29% of the borderline group. Optic neuritis was present in 2% of the control group, and in 9.5% of the borderline group. The report of a ± nonreactive or borderline FTA-ABS test is significant to the clinician. Not only should the test be repeated, but a careful history should be taken and a complete examination for subtle signs of late ocular and neurosyphilis should be performed.
Tatiana Vaz Leite Pinto, Antônio Pereira Gomes Neto, Matheus Nader Cunha, Letícia Moreira Bernardino, Paulo Pereira Christo
Published: unknown date
Abstract:
Background: In the era of the re-emergence of syphilis, ocular syphilis has gained attention because its prevalence has increased and it can cause blindness and disability. Objectives: To investigate the clinical presentation and prognosis of ocular syphilis. Methods: Prospective study on 53 patients (90 eyes) with ocular syphilis diagnosed at the Santa Casa of Belo Horizonte, Brazil. The diagnosis was based on clinical manifestations of the disease and on serological markers (positive serum treponemal and non-treponemal tests or two positive treponemal tests). Results: Thirty-five eyes (66%) were from men and the mean age was 45.3 ± 12.0 years. HIV coinfection was confirmed in 10 patients (18.9%). Forty-four (84.9%) had VDRL titers ≥ 1:32. Bilateral ocular involvement occurred in 68%. Optic neuritis was diagnosed in 51.7% of the eyes and uveitis in 48.2%. Regarding visual acuity, the median baseline logarithm of the minimum angle of resolution (logMAR) was 1 (20/200 Snellen), while after antibiotic therapy, the median was 0.2 (20/30 Snellen). Poor visual acuity after treatment, defined as the best-corrected visual acuity (BCVA; logMAR 1; 20/200 Snellen) or worse, was associated with severe BCVA at presentation (below logMAR 1.3; 20/400 Snellen) (p = 0.001) and age over 50 years (p = 0.001). Conclusions: This study confirms the wide spectrum of clinical manifestations of ocular syphilis. The most frequent form was optic neuritis, an important differential diagnosis from other causes of inflammatory neuritis. Early diagnosis is essential, given that this is a treatable condition with excellent visual recovery in most cases.
G Boudin
Published: 11 May 1964
La Revue du praticien, Volume 14

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