Julie Vadboncoeur1, Annie-Claude Labbé2, Claude Fortin3, Bouchra Serhir4, Yasmine Rabia5, Kinda Najem6, Laurence Jaworski7, Marie-Josée Aubin8. 1. Ophthalmology Resident, Université de Montréal, Montreal, Que.. Electronic address: julie.vadboncoeur@umontreal.ca. 2. Division of Infectious Diseases and Medical Microbiology, Hôpital Maisonneuve-Rosemont (HMR), CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Que.; Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Montreal, Que. 3. Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Que. 4. Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Ste-Anne-de-Bellevue, Que. 5. Ophthalmology Resident, Université de Montréal, Montreal, Que. 6. Department of Ophthalmology, CUO-HMR, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Que. 7. Department of Ophthalmology, CHUM, Montreal, Que. 8. Department of Ophthalmology, CUO-HMR, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Que.; Department of Social and Preventive Medicine, School of Public Health, Université de Montreal, Montreal, Que.
Abstract
OBJECTIVE: To describe the demographics, clinical presentation, proportion of co-infection with human immunodeficiency virus (HIV), and treatment of patients with ocular syphilis seen at the ophthalmology department of 2 tertiary centres in Montreal, Canada. DESIGN: Retrospective case series. PARTICIPANTS AND METHODS: A total of 169 eyes of 115 patients, seen between 2000 and 2015, with a positive syphilis treponemal serology and a likely syphilis-related ophthalmologic diagnosis. Subgroup analysis was performed between HIV-infected and HIV-uninfected patients. RESULTS: Mean age of onset was 55 years, and 79% were male. Mean presenting logMAR visual acuity was 0.7. HIV status was available for 66%, of whom 49% were HIV-infected. The anatomical ocular diagnoses included isolated anterior uveitis (18%) and posterior segment involvement (42%). Both eyes were affected in 47%. Lumbar puncture (LP) was performed in 55%, of whom 22% had a positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test. Antibiotherapy, consisting of intravenous penicillin alone or in addition to intramuscular benzathine penicillin, was administered in 65 patients (69%). Treatment allowed a visual improvement of -0.23 logMAR. HIV-infected patients were younger men (p < 0.01) and had more abnormal CSF analysis (p = 0.02), but there were no statistically significant differences in the anatomical location of ocular inflammation or visual function improvement. CONCLUSIONS: Given its varied presentations, syphilis must always be part of the differential diagnosis of intraocular inflammation. HIV testing and an LP are required in the evaluation of ocular syphilis, which should be treated as neurosyphilis with the appropriate regimen.
OBJECTIVE: To describe the demographics, clinical presentation, proportion of co-infection with human immunodeficiency virus (HIV), and treatment of patients with ocular syphilis seen at the ophthalmology department of 2 tertiary centres in Montreal, Canada. DESIGN: Retrospective case series. PARTICIPANTS AND METHODS: A total of 169 eyes of 115 patients, seen between 2000 and 2015, with a positive syphilis treponemal serology and a likely syphilis-related ophthalmologic diagnosis. Subgroup analysis was performed between HIV-infected and HIV-uninfected patients. RESULTS: Mean age of onset was 55 years, and 79% were male. Mean presenting logMAR visual acuity was 0.7. HIV status was available for 66%, of whom 49% were HIV-infected. The anatomical ocular diagnoses included isolated anterior uveitis (18%) and posterior segment involvement (42%). Both eyes were affected in 47%. Lumbar puncture (LP) was performed in 55%, of whom 22% had a positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test. Antibiotherapy, consisting of intravenous penicillin alone or in addition to intramuscular benzathine penicillin, was administered in 65 patients (69%). Treatment allowed a visual improvement of -0.23 logMAR. HIV-infected patients were younger men (p < 0.01) and had more abnormal CSF analysis (p = 0.02), but there were no statistically significant differences in the anatomical location of ocular inflammation or visual function improvement. CONCLUSIONS: Given its varied presentations, syphilis must always be part of the differential diagnosis of intraocular inflammation. HIV testing and an LP are required in the evaluation of ocular syphilis, which should be treated as neurosyphilis with the appropriate regimen.