The Great Imitator: Ocular Syphilis Presenting as Posterior Uveitis
The Great Imitator: Ocular Syphilis Presenting as Posterior Uveitis
复制标题
DOI：
10.12659/ajcr.893907
复制
发表时间：
2015-01-01
影响因子：
1.2
通讯作者：
Ge, Phillip S.
中科院分区：
文献类型：
--
作者：
Kuo, Alan;Ziaee, Saba M.;Ge, Phillip S.
目的：罕见疾病背景：梅毒通常被称为“伟大的模仿者”。后葡萄膜炎的鉴别诊断很广泛，眼梅毒的诊断尤其困难，因为它的表现与其他眼部疾病（例如急性视网膜坏死）类似。 病例报告：一名 34 岁女性，过去几年有多个性伴侣，出现疼痛且逐渐恶化的单侧视力丧失 2 周。几个月前，她报告了头痛和弥漫性皮疹等非特异性症状。尽管口服阿昔洛韦治疗3周，她的视力逐渐下降，她被转诊至大学眼科诊所进行进一步评估。经检查，担心出现急性视网膜坏死，并在等待进一步的传染病研究结果的同时，对她进行了肠外阿昔洛韦的经验性治疗。检查最终发现眼梅毒，脑脊液研究也进一步证实了神经梅毒。视力完全恢复后立即开始静脉注射青霉素治疗。结论：眼梅毒的表现差异很大，所有后葡萄膜炎患者都应予以考虑，尤其是有头痛和皮疹病史的患者。然而，鉴于急性视网膜坏死是后葡萄膜炎的更常见原因，并可迅速导致永久性视力丧失，因此只要怀疑，就应根据经验进行治疗，同时进行检查以评估其他诊断。
Objective: Rare diseaseBackground: Syphilis is often known as the "Great Imitator". The differential diagnosis of posterior uveitis is broad with ocular syphilis being particularly challenging to diagnose as it presents similarly to other ocular conditions such as acute retinal necrosis.Case Report: A 34-year-old woman with multiple sexual partners over the past few years presented with painful and progressively worsening unilateral vision loss for 2 weeks. Several months prior, she had reported non-specific symptoms of headache and diffuse skin rash. Despite treatment with oral acyclovir for 3 weeks, her vision progressively declined, and she was referred to the university ophthalmology clinic for further evaluation. On examination, there was concern for acute retinal necrosis and she was empirically treated with parenteral acyclovir while awaiting further infectious disease study results. Workup ultimately revealed ocular syphilis, and neurosyphilis was additionally confirmed with cerebrospinal fluid studies. Treatment with intravenous penicillin was promptly initiated with complete visual recovery.Conclusions: Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis, especially with a history of headache and skin rashes. However, given that acute retinal necrosis is a more common cause of posterior uveitis and can rapidly result in permanent vision loss, it should be empirically treated whenever it is suspected while simultaneous workup is conducted to evaluate for alternative diagnoses.