Frei J., Schröder B., Messerli J.

Universitäts-Augenklinik, Mittlere Strasse 91, CH-4012 Basel

Background: Nowadays ophthamologists are rarely confronted with many and diverse ocular manifestations of lues. This case report demonstrates that serology for lues can help to find the correct diagnosis in unclear conditions of inflammation.
History and signs: A 35-year-old Portuguese male patient consulted our clinic, complaining of reduced visual acuity on the left eye for two days. Visual acuity was 1.0 (20/20) on the right eye and 0.2 (20/100) on the left eye. Biomicroscopy of the anterior segment in both eyes was normal. On the left eye, fundoscopy revealed a diffuse maculopathy with oedema, choroidal greyish-coloured areas and a small haemorrhage. The vitreous was free of cellular infiltration. A fluorescein angiography showed granulomatous choroidal changes with a diffuse leakage in the macular region on the left eye. Therefore, an inflammatory cause was likely. A blood sample for inflammatory parameters and serology for borrelia and lues - among others- was taken. With a normal chest X-ray, normal serological values for ACE and lysozym, negative conjunctival biopsy and a negative Multitest Mérieux, sarcoidosis seemed very unlikely. With a positive serology for lues the diagnosis of a luetic chorioretinitis was clear.
Therapy and outcome: The patient received a treatment with penicillin G intravenously. Under this therapy visual acuity recovered completely with slight scarring on the macula.
Conclusion: Lues must be considered as a - relatively rare - cause of ocular inflammation in any adult, especially in unclear situations.

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