Location
Moultrie, GA
Start Date
7-5-2025 1:00 PM
End Date
7-5-2025 4:00 PM
Description
Introduction: Syphilis is caused by the spirochete, Treponema pallidum. In 2023, over 200,000 cases of syphilis including congenital syphilis were reported in the US, which was a 61 percent increase since 2019. Ocular syphilis is rare but is a growing concern given the rising incidence of syphilis. Delay in diagnosis and treatment can lead to vision loss. The aim of this report is to present a unique case of ocular syphilis and its associated findings.
Case Presentation: This is a case of a 58-year-old male in a large metropolitan city presented to an ophthalmologist complaining of floaters and blurry vision in both eyes. Vision with correction at initial visit was 20/20 in both eyes. There was evidence of mild cells and flares in the anterior chambers for which the patient was treated with topical steroids. In the next few days, vision deteriorated to 20/100 in both eyes, and optical coherence tomography (OCT) showed nodular changes in the photoreceptor layers. After testing positive for tertiary syphilis, visual symptoms resolved after intravenous course of penicillin G.
Discussion: Studies have documented rises in ocular syphilis with a hefty proportion of cases associated with men who have sex with men. Diagnosis of ocular syphilis is a challenge given its similarities in presenting symptoms to other ocular diseases such as uveitis, vasculitis, and optic neuritis. A lack of pathognomonic presentation makes it difficult to initiate timely testing and often leads to misdiagnosis or delayed diagnosis. Here we present a constellation of symptoms with physical findings as well as changes on OCT that should raise suspicion for ocular syphilis, especially in high-risk populations.
Embargo Period
6-17-2025
Included in
Case report: ocular syphilis with rapid loss of visual acuity
Moultrie, GA
Introduction: Syphilis is caused by the spirochete, Treponema pallidum. In 2023, over 200,000 cases of syphilis including congenital syphilis were reported in the US, which was a 61 percent increase since 2019. Ocular syphilis is rare but is a growing concern given the rising incidence of syphilis. Delay in diagnosis and treatment can lead to vision loss. The aim of this report is to present a unique case of ocular syphilis and its associated findings.
Case Presentation: This is a case of a 58-year-old male in a large metropolitan city presented to an ophthalmologist complaining of floaters and blurry vision in both eyes. Vision with correction at initial visit was 20/20 in both eyes. There was evidence of mild cells and flares in the anterior chambers for which the patient was treated with topical steroids. In the next few days, vision deteriorated to 20/100 in both eyes, and optical coherence tomography (OCT) showed nodular changes in the photoreceptor layers. After testing positive for tertiary syphilis, visual symptoms resolved after intravenous course of penicillin G.
Discussion: Studies have documented rises in ocular syphilis with a hefty proportion of cases associated with men who have sex with men. Diagnosis of ocular syphilis is a challenge given its similarities in presenting symptoms to other ocular diseases such as uveitis, vasculitis, and optic neuritis. A lack of pathognomonic presentation makes it difficult to initiate timely testing and often leads to misdiagnosis or delayed diagnosis. Here we present a constellation of symptoms with physical findings as well as changes on OCT that should raise suspicion for ocular syphilis, especially in high-risk populations.