Title : Ocular syphilis with concomitant neurosyphilis and tuberculosis: A case report
Abstract:
Syphilis is a venereal or vertically transmitted infectious disease caused by Treponema pallidum, a corkscrew shaped, motile spirochete. It generally progresses via stages and, if left untreated, can result in devastating cardiovascular and neurological sequelae.
Ocular syphilis refers to infectious inflammation within any portion of the eye. It typically results in uveitis, but can also cause optic neuropathy, retinal vasculitis and interstitial keratitis. It presents as diminished visual acuity and delayed treatment may result in permanent vision loss. Similar to neurosyphilis, ocular syphilis can occur during any infectious stage.
Towards the end of the 20th century, significant progress in syphilis prevention resulted in an all time low prevalence in high income countries, such as the United States. This rare complication only had an annual incidence of 0.3 cases per million adults between 2009 to 2011. However, there have been concerns of increased prevalence in syphilis in the past decade. The prevalence of syphilis complications has also increased during this time span, including ocular syphilis. This trend is consistent globally, with noteworthy data arising from Europe, North America, and South America. In 2016, the World Health Assembly adopted a strategy with the intention to reduce the incidence of global syphilis by 90% from 2018 to 2030.
We present a rare case of ocular syphilis in a 61 year old, immunocompetent male. The patient’s ocular syphilis manifested as left chorioretinitis, resulting in progressive monocular vision loss. The patient cited concerns for memory loss, and lumbar puncture confirmed concomitant neurosyphilis. His condition was complicated with latent tuberculosis. Administration of penicillin resulted in improvement of symptoms.
This report highlights the reemergence of ocular and neurosyphilis. Emphasis should be placed on appropriate identification of ocular syphilis in a timely manner. In doing so, swift antibiotic management can subsequently prevent morbid visual and neurological sequelae.
