1571. Ocular Syphilis: Case Series and Review
Session: Poster Abstract Session: Clinical Infectious Diseases: Sexually Transmitted Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: Increasing cases of ocular syphilis (OS), primarily affecting men who have sex with men (MSM) with HIV, have been reported recently.  OS can occur at any stage of syphilis, with varied manifestations, however outcome data remains limited. We review 3 recent cases of OS, with focus on clinical features and outcomes.

Methods: Retrospective chart review of 3 cases of OS.

Results: Case 1: 38 yo HIV positive male with 1 week of vision loss, pain, and redness in his L eye. Visual acuity (VA) was light perception and exam showed anterior uveitis.  RPR and FTA-ABS were positive.  Lumbar puncture (LP) showed no inflammation and CSF-VDRL was negative. VA improved to 20/100 with treatment. Case 2: 51 yo male with 4 days of blurry vision of his R eye, headache (HA) and neck pain. Seven months prior, he had a self-resolving rash, joint pain, lymphadenopathy (LAD), and malaise. VA was finger counting and exam showed optic neuritis.  RPR and FTA-ABS were positive.  LP showed inflammation and positive CSF-VDRL. VA improved to 20/30 with treatment. Case 3: 48 yo male with scleral injection followed by blurry vision of L eye.  Three weeks prior, he had a rash, LAD, HA, alopecia, and weight loss.  VA was 20/40 with bilateral disc edema and panuveitis on exam.  RPR and FTA-ABS were positive.  LP showed inflammation and positive CSF-VDRL.  Visual deficits resolved with treatment.

Conclusion: This case series depicts the clinical features and outcomes of 3 recent OS cases. Each occurred in MSM with high risk sexual behaviors and high RPR titer. Eye exam findings were variable, however an inflammatory CSF correlated with VDRL and posterior eye involvement. With treatment, all patients improved.  

1

2

3

Risk Factors

MSM, unprotected sex

MSM, multiple partners, unprotected sex

MSM, multiple partners, unprotected sex

HIV

+

-

-

 VA /Eye Exam

light perception

anterior uveitis

finger counting

optic neuritis

20/40

disc edema, pan uveitis

Syphilis Stage

2o

2o

2o

RPR

1:128

1:1024

1:128

FTA-ABS

+

+

+

CSF VDRL

-

+

+

CSF

Normal (nl)

wbc 9

protein 51 mg/dL

wbc 58

protein 75 mg/dL

MRI

nl

nl

nl

Treatment

(PCN=IV penicillin G 24 mU/day x 14 d)

PCN

ocular prednisolone, timolol, atropine

PCN

PCN

ocular prednisolone

zyrtec

VA post treatment

20/100

20/30

20/20

Emily Colgate, MD, Internal Medicine, Santa Barbara Cottage Hospital, Santa Barbara, CA, Lynn Fitzgibbons, MD, Santa Barbara County Public Health Dept, Santa Barbara, CA, Alan Sugar, MD, Sansum Clinic, Santa Barbara Cottage Hospital, Santa Barbara, CA and Douglas Jacobson, MD, Eye Specialists of Santa Barbara, Santa Barbara, CA

Disclosures:

E. Colgate, None

L. Fitzgibbons, None

A. Sugar, None

D. Jacobson, None

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