Background Increased incidence of syphilis has been observed in developed countries in the last decade. In some cases uveitis indistinguishable from that related to non-infectious autoimmune uveitis may be the presenting manifestation of syphilis.
Objectives From a wide series of patients with syphilitic uveitis our aims were: 1) To describe the clinical features and visual outcomes. 2) To assess differences with syphilitic patients without uveitis in demographic features, HIV status, viral load and CD4 count and cerebrospinal fluid findings.
Methods Retrospective and comparative case series study. Since year 2000, 50 patients (19 females/31 males) with 45±17 years were diagnosed as having syphilitic uveitis in 8 centers from Spain. Other 86 randomly selected syphilitic patients without uveitis diagnosed in the same centers during the same period were included. Clinical and laboratory data were collected from the clinical records. Continuous variables (normally and not normally distributed) were compared with the 2-tailed Student’
Results The most frequent anatomic uveitic pattern was posterior; 26 (52%) cases. Granulomatous inflammation of the anterior chamber was observed in 3 (6%) patients. Several types of posterior segment inflammation were observed: optic neuritis (40%), vitritis (35%), necrotizing retinopathy (35%), retinal vasculitis (20%), posterior placoid chorioretinitis (10%), multifocal chorioretinitis (10%), macular edema (7.5%), serous retinal detachment (5%), neuroretinitis (5%), multifocal choroiditis (2.5%).
Mean ± SD initial visual acuity (VA) of right and left eyes (RE, LE) was 0.43±0.37 and 0.49±0.37 respectively. After a mean follow-up of 27.1±3 months final VA was statistically better in both eyes (RE: 0.72±0.34; p=0.012 and LE: 0.75±0.33; p=0.012).
We did not find differences in syphilitic patients with and without uveitis in age and sex distribution. We observed more frequently homosexual and HIV+ patients in the group of uveitis (p=0.002 and p=0.032). HIV patients from both groups did not presented differences in CD4 count and viral load. Patients with uveitis had higher amount of cells in cerebrospinal fluid: 5 (0-10400) vs 1 (0-50) p=0.020. No differences were observed in the concentration of proteins and frequency of positive serology.
Conclusions We observed an increased incidence of syphilis presenting as uveitis in our Uveitis Units. High level of suspicion for this infection is required to establish an early diagnosis and appropriate treatment. In this relatively large series of patients with syphilitic uveitis, posterior uveitis was the most frequent type of uveitis. Prognosis was favourable in terms of VA. Patients with syphilitic uveitis presented more frequently homosexual practices, HIV+ and presented a greater number of cells in the cerebrospinal fluid.
Disclosure of Interest None Declared