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A case of syphilis uveitis that initially presented as prolonged conjunctivitis Rokuki Kiyosawa 1 , Kyouhei Umemura 2 , Shuto Yamashita 1 , Kazuyuki Kumagai 1 , Mariko Furukawa 1 1Department of Ophthalmology, Kami-iida Daiichi General Hospital 2Department of Ophthalmology, Aichi Medical University pp.774-779
Published Date 2023/6/15
DOI https://doi.org/10.11477/mf.1410214829
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Abstract Purpose:To report a case of syphilis uveitis that initially presented as prolonged conjunctivitis.

Case:The patient was a 79-year-old man who had a history of bilateral primary open angle glaucoma and cataract. He visited the hospital with a chief complaint of conjunctival hyperemia in the right eye. In February of the year X, his right eye showed acute conjunctivitis and he had received topical antibiotics and steroids. Three weeks later, ciliary hyperemia and hypopyon were found in his right eye. He was diagnosed with syphilis uveitis by serological test.

Findings:At his first visit, his best corrected visual acuity was 0.2 in the right eye and 0.3 in the left eye. Other than conjunctivitis of his right eye no other conditions were observed. Three weeks later, his right eye developed ciliary hyperemia, hypopyon and vitreous opacity and the visual acuity decreased. The fundus could not be observed. The syphilis serodiagnosis was positive. We referred the patient to Aichi Medical University for further investigations. Polymerase chain reaction testing of the hydatoid and cerebrospinal fluid(CSF)were negative to identify syphilis. Nothing particular had been found in skin, neurological examination, and brain magnetic resonance imaging test. Since the CSF protein was high and fluorescent treponemal antibody absorption was positive in the CSF test, he was diagnosed with asymptomatic neurosyphilis. He started receiving intravenous ceftriaxone sodium hydrate and topical antibiotics, steroid, mydriatic and glaucomatous. Three weeks later, the ciliary hyperemia and hypopyon disappeared and the visual acuity increased to 0.2. He continued the topical administrations, and the uveitis had improved 2 months later.

Conclusions:Since ocular syphilis has various clinical manifestations, syphilis serodiagnosis is useful for diagnosis. Additionally, it is important to investigate systemic complications even though it is asymptomatic.


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