J Guber1, U Schneider, P B Henrich. 1. Augenklinik, Universitätsspital Basel, Mittlere Strasse 91, 4031 , Basel, Schweiz. GuberJ@uhbs.ch
Abstract
BACKGROUND: Since the 1990s an increase in the incidence of syphilis has been observed. The classical course of syphilis can be subdivided into three stages. Ocular involvement is particularly possible in stage III. The disease can be efficiently treated by antibiotic therapy. METHODS: We report on the case of a 38-year-old patient who presented with loss of nasal visual field and hazy vision in the left eye which had suddenly appeared 2 weeks previously. The patient had received an intravitreal injection of triamcinolon 6 weeks prior to this for mainly left-sided cystoid macular edema which had been interpreted as the manifestation of hypertensive retinopathy by blood pressures of 200/130. RESULTS: An arterial branch occlusion temporal superior could be detected biomicroscopically as well as multiple sharply defined, whitish-yellow, epiretinal and intraretinal spots and lightly blurred papillary edges. Lues serology revealed very high titers. After 2 weeks of i.v. penicillin G therapy there was a clear regression of the chorioretinal foci but persistence of the reduction in vision and loss of visual field. CONCLUSIONS: Because of the increasing incidence of syphilis it is becoming more important to consider this disease in the differential diagnosis not only for unclear symptom complexes but also in apparently obvious situations.
BACKGROUND: Since the 1990s an increase in the incidence of syphilis has been observed. The classical course of syphilis can be subdivided into three stages. Ocular involvement is particularly possible in stage III. The disease can be efficiently treated by antibiotic therapy. METHODS: We report on the case of a 38-year-old patient who presented with loss of nasal visual field and hazy vision in the left eye which had suddenly appeared 2 weeks previously. The patient had received an intravitreal injection of triamcinolon 6 weeks prior to this for mainly left-sided cystoid macular edema which had been interpreted as the manifestation of hypertensive retinopathy by blood pressures of 200/130. RESULTS: An arterial branch occlusion temporal superior could be detected biomicroscopically as well as multiple sharply defined, whitish-yellow, epiretinal and intraretinal spots and lightly blurred papillary edges. Lues serology revealed very high titers. After 2 weeks of i.v. penicillin G therapy there was a clear regression of the chorioretinal foci but persistence of the reduction in vision and loss of visual field. CONCLUSIONS: Because of the increasing incidence of syphilis it is becoming more important to consider this disease in the differential diagnosis not only for unclear symptom complexes but also in apparently obvious situations.