P 403
Misdiagnosis and immunosuppressive treatment of uveitis in syphilis
A. Walter, V. Knospe
Introduction: To analyze the diagnostic spectrum and factors contributing to the misdiagnosis and erroneous medical treatment of syphilis with a pri- marily ocular manifestations in view of the CDC eradication project.
Patients: We report on 16 patients seen in 1999 (13 male, 3 female, age 25-70, mean 45 yrs) presenting with retinal vasculitis (5 pat., 10 eyes), optic (peri)neuritis (8 pat., 15 eyes), optic atrophy (3 pat., 6 eyes), choroiditis, chorioretinitis and choriocapillaritis (3 pat., 5 eyes), iritis (2 pat., 3 eyes), ke- ratouveitis and precipitates (3 pat., 5 eyes), facial skin lesions (1 pat.). Dia- gnoses leading to a delayed onset of treatment were sarcoidosis, Behyet's, allergic exanthema, ptosis, Horner's, vasculitis, conjunctivitis, night blind- ness, central serous retinopathy, chorioretinitis, visual field defects, and meningoencephalitis of unknown origin. Ten patients were HIV-1 serocon- verted (2x first diagnosis) one seroconverted for syphilis only 3 weeks after presentation. Intense systemic immunosupression of two patients resulted in an aspergillus septicemia in one, and renal tubular insufficiency and hy- pertonus in the other without diminishing the intensity of ocular inflamma- tion. The inflammations resolved using standard treatment with intravenous ceftriaxone.
Conclusions: The incidence of syphilis has decreased, and many ophthal- mologists and neurologists are not any longer aware of this infection. How- ever, our study shows that it must still be included in the differential diagno- sis of inflammatory intraocular diseases in referral centers. Follow-up sero- logy in negative cases is imperative in suspected cases as weil as is HIV testing. If there is an organ manifestation such as the eye, the erroneous laboratory comment "spontaneously cured syphilis" should not be used.
University Eye Hospital Eppendorf, Martinistr. 52, D-20251 Hamburg, Germany