Título / Title

POSTERIOR UVEITIS BY SYPHILIS: A CASE REPORT

Introdução / Purpose

Cases of ocular syphilis are increasing and have wide range of presentations: iridocyclitis (71%), panuveitis, posterior uveitis (8%) and keratouveitis (8%).

Material e Método / Methods

A retrospective case chart review study, patient treated at Hospital de Olhos de Blumenau in 2021.

Resultados / Results

A 42-year-old male patient, with diabetes mellitus for 5 years with good control and no insulin therapy, complained of visual loss in the right eye (OD) with 1 day of evolution. Visual acuity (VA) was 20/40 in OD and 20/20 in the left eye (OS). Biomicroscopy and intraocular pressure without changes in both eyes (OU). Fundoscopy OD: mild vitreous clouding and microhemorrhages in the macula; OS: no changes. On Optical Coherence Tomography (OCT) OD: hyper-reflective spots at the level of the external retina and discrete focal disruptions in the ellipsoid zone; OS no alterations. A fluorescein angiography showed in OD hypofluorescent lesions in the early phases that became hyperfluorescent in the late phases, more concentrated in the macular region, associated with late optic nerve hyperfluorescence and contrast uptake in the vessel wall, suggestive of active posterior uveitis; OS without changes. The diagnosis of syphilis was confirmed through the result of the VDRL in the titration 1:64 and FTA-ABS reagent. Referred for hospitalization and treatment of neurosyphilis with Crystalline Penicillin. Patient returned at 6 weeks with significant improvement in complaints and VA of 20/20 OU.

Discussão e Conclusões / Conclusion

Fistly, it is important to value the patient's complaint and request additional tests when there is no justification in the physical examination, as in the present case where the suspicion of posterior uveitis was with fluorescein angiography. In all uveitis, it is first necessary to exclude infectious diseases. The correct diagnosis is important for treatment and prevention of advancement to the meninges and the central nervous system. Ocular involvement should be treated as neurosyphilis. Prolonged follow-up is necessary.

Palavras Chave

Ocular Syphilis; Uveitis

Area

CLINICAL RETINA