Objectives Syphilitic Uveitis (SU) may be the first manifestation of syphilis. SU may be indistinguishable morphologically from other etiologies causing uveitis. Our aim was to study and describe the SU as first manifestation of syphilis.
Methods We describe 11 patients with SU diagnosed at our Hospital from 2006 to 2013. Diagnosis was based on active uveitis and specific microbiological test. To evaluate neurological involvement, a lumbar puncture was performed in 9 patients.
Results Eleven patients (3 women/8 men) with a mean age of 45.8±13.8 years (range 26 -70) were diagnosed as having SU. First syphilitic manifestation was uveitis (n=9) and mucocutaneous lesions (n=2). The pattern of uveitis were: posterior (n=6), panuveitis (n=3), and anterior (n=2). Ocular involvement was unilateral (n=8) and bilateral (n=3). The median diagnostic delay was 0,75 months (IQR 0-2) (range 0-12). Positive serology of HIV (n=3) and neurosyphilis (n=2) were observed. Treatment was based on penicillin G (4 million-units/4h/i.v.) for 14 days (n=8) and for 21 days (n=2), and doxicillin 100 mg/12h for 28 days, because of allergic condition (n=1). We had a relapse in one case treated initially with benzathine penicillin/1.2 MU/i.m x 3 day, and then with penicillin G 4MU/4h ev x 21 days. The median of visual acuity improved from 0,1 (IQR 0,05-0,3; range 0-0.8) to 0.6 (IQR 0,05-0,9; range 0,05-1) after treatment. The main ocular complications of SU were complete unilateral ocular blindness (n=3), retina detachment (n=2), cataract (n=1), and increased ocular tension (n=1).
Conclusions It is recommended to include SU in the differential diagnosis of uveitis.
Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias”PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest None declared