![]() Review of systems was negative except for recent alopecia 18, 19 The patient was a sexually active homosexual male with a negative HIV test three months prior. CASE REPORTĪ 24-year-old male presented to the emergency department (ED) with five days of acute painless progressive bilateral loss of vision without photophobia, discharge, trauma, or contact lens use. 1, 3, 4, 5 Delay or lack of treatment may lead to long-term neurologic complications such as blindness, paralysis, dementia, psychosis and stroke. 10, 11 Centers for Disease Control and Prevention (CDC) guidelines now recommend that any ocular manifestation of syphilis such as iritis, uveitis, or chorioretinitis, be treated as neurosyphilis, with a 14-day course of intravenous (IV) penicillin G, regardless of the stage of clinical presentation of syphilis or lumbar puncture (LP) results. Painless bilateral loss of vision may be the only presenting symptom of syphilis, which can be observed in up to one-third of patients with neurosyphilis. As emergency physicians we should be aware and be able to recognize manifestations of ocular syphilis as a cause of painless vision loss and its high rate of coinfection with HIV. 1- 9 Most of the case studies on ocular syphilis are isolated to the ophthalmology literature. The incidences of syphilis were highest among women in age groups 25 to 29 years and 20 to 24 years in men, especially in men who have sex with men (MSM). 1 Syphilis is a common worldwide sexually transmitted infection and is notorious for facilitating the transmission of the human immunodeficiency virus (HIV). ![]() 1, 3, 4, 9 In 2000, the rates of syphilis were at an all-time low (2.2 cases per 100,000 persons) but by 2013 had more than doubled (5.5 cases per 100,000 persons). 15 Currently there is a re-emergence of syphilis for which the case count and rate is the highest recorded since 1995 in the United States. Syphilis is known as the “great imitator” for its ability to infect any organ and cause diverse symptoms. For emergency physicians it is important to be aware of iritis, uveitis, or chorioretinitis as ocular manifestations of neurosyphilis especially in this high-risk population and to obtain RPR and HIV tests in the ED to facilitate early diagnosis, and treatment and to prevent irreversible vision loss. There is a paucity of emergency medicine literature on ocular syphilis. The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. Ocular manifestations of syphilis can present at any stage of syphilis. The patient’s history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR) and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis. This is a case of a 24-year-old male who presented to our ED with bilateral painless vision loss. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM). This is an unusual presentation of syphilis and one that emergency physicians should be aware of. ![]() This case describes an emergency department (ED) presentation of ocular syphilis in a human immunodeficiency virus (HIV) infected patient.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |