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   Table of Contents      
PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 2  |  Page : 149-150

Syphilitic uveitis as the presenting feature of HIV


1 Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
2 Department of Uveitis and Inflammatory Disorders, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission24-Jan-2015
Date of Acceptance19-Oct-2015
Date of Web Publication5-Apr-2016

Correspondence Address:
Dr. Ekta Rishi
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.179714

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  Abstract 

Keywords: Acquired immune deficiency syndrome, eye, human immunodeficiency virus, syphilis, uveitis


How to cite this article:
Rishi E, Govindarajan MV, Biswas J, Agarwal M, Sudharshan S, Rishi P. Syphilitic uveitis as the presenting feature of HIV. Indian J Ophthalmol 2016;64:149-50

How to cite this URL:
Rishi E, Govindarajan MV, Biswas J, Agarwal M, Sudharshan S, Rishi P. Syphilitic uveitis as the presenting feature of HIV. Indian J Ophthalmol [serial online] 2016 [cited 2018 Nov 20];64:149-50. Available from: http://www.ijo.in/text.asp?2016/64/2/149/179714

A 25-year-old male presented with visual loss in the right eye for 20 days and best-corrected visual acuity of counting fingers in the right eye and 20/20 in the left eye. The anterior chamber (AC) had old keratic precipitates, no AC reaction, dense vitritis, active multifocal retinochoroiditis, and retinal vascular sheathing in all quadrants. The left eye showed sheathed blood vessels with chorioretinal atrophy [Figure 1].
Figure 1: (a) Color fundus montage of the right eye shows vitritis, vascular sheathing, and retinochoroidal infiltrates. (b) Enlarged view of multifocal retinochoroidal infiltrates with vitreous exudates in the right eye. (c) Color fundus montage of left eye showing vascular sclerosis and healed retinochoroiditis in the superotemporal quadrant

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The regular bacteriologic and viral investigations on the aqueous and vitreous samples were negative. ELISA for HIV 1 and 2 was positive. Rapid plasma regain (RPR) was reactive at a dilution of >1:32, and Treponema pallidum hemagglutination assay (TPHA) was positive at more than 1:1280 dilution [Table 1].
Table 1: Investigations carried out and their results

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The patient was started on tapering dose of oral steroids (1 mg/kg/day), antiretroviral therapy (tenofovir 300 mg, lamivudine 300 mg, and efavirenz 600 mg once daily). Intramuscular penicillin was administered for 3 weeks (2.4 million units every week).

After 2 months, visual acuity improved to 20/30, and vitreous inflammation cleared leaving behind retinal pigment epithelium mottling [Figure 2].
Figure 2: Color fundus montage picture of the right eye showing resolution of vitritis and retinochoroiditis with retinal pigment epithelium mottling 2 months following initiation of treatment

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  Discussion Top


Syphilis is caused by the spirochete, Treponema pallidum. The disease has also been referred to as the great imitator.[1],[2]

The prevalence of syphilis had decreased in the preceding two decades. At present, up to 70% patients with ocular syphilis are HIV positive. Syphilis is the underlying cause of uveitis in 16.4% of all cases.[3] Generalized creamy white infiltrates and diffuse retinitis is a peculiar feature of advanced syphilitic uveitis.[4]

Syphilis elicits both a humoral and a cell-mediated immune response and can be detected by RPR and TPHA tests.[5]

This case emphasizes that syphilitic uveitis can present as a feature of undetected HIV. One needs to have a high degree of suspicion to arrive at a correct diagnosis and to institute prompt therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Puech C, Gennai S, Pavese P, Pelloux I, Maurin M, Romanet JP, et al. Ocular manifestations of syphilis: Recent cases over a 2.5-year period. Graefes Arch Clin Exp Ophthalmol 2010;248:1623-9.  Back to cited text no. 1
    
2.
Durnian JM, Naylor G, Saeed AM. Ocular syphilis: The return of an old acquaintance. Eye (Lond) 2004;18:440-2.  Back to cited text no. 2
[PUBMED]    
3.
Rose-Nussbaumer J, Goldstein DA, Thorne JE, Arantes TE, Acharya NR, Shakoor A, et al. Uveitis in human immunodeficiency virus-infected persons with CD4+ T-lymphocyte count over 200 cells/mL. Clin Experiment Ophthalmol 2014;42:118-25.  Back to cited text no. 3
    
4.
Fu EX, Geraets RL, Dodds EM, Echandi LV, Colombero D, McDonald HR, et al. Superficial retinal precipitates in patients with syphilitic retinitis. Retina 2010;30:1135-43.  Back to cited text no. 4
    
5.
Eandi CM, Neri P, Adelman RA, Yannuzzi LA, Cunningham ET Jr.; International Syphilis Study Group. Acute syphilitic posterior placoid chorioretinitis: Report of a case series and comprehensive review of the literature. Retina 2012;32:1915-41.  Back to cited text no. 5
    


    Figures

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    Tables

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