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Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases

OBJECTIVES: To define the clinical features of ocular syphilis and analyze the cerebrospinal fluid (CSF) of ocular syphilis patients to determine the co-occurrence of neurosyphilis. METHODS: This was a retrospective study of 17 patients (23 eyes) with ocular syphilis admitted to the Fifth People...

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Autores principales: Xu, Yating, Li, Jingjing, Xu, Yuxuan, Xia, Wei, Mo, Xingfan, Feng, Mingzhi, He, Fanghua, Li, Shanshan, Du, Fangzhi, Wang, Qianqiu, Wu, Minzhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621597/
https://www.ncbi.nlm.nih.gov/pubmed/36325386
http://dx.doi.org/10.3389/fmed.2022.1037712
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author Xu, Yating
Li, Jingjing
Xu, Yuxuan
Xia, Wei
Mo, Xingfan
Feng, Mingzhi
He, Fanghua
Li, Shanshan
Du, Fangzhi
Wang, Qianqiu
Wu, Minzhi
author_facet Xu, Yating
Li, Jingjing
Xu, Yuxuan
Xia, Wei
Mo, Xingfan
Feng, Mingzhi
He, Fanghua
Li, Shanshan
Du, Fangzhi
Wang, Qianqiu
Wu, Minzhi
author_sort Xu, Yating
collection PubMed
description OBJECTIVES: To define the clinical features of ocular syphilis and analyze the cerebrospinal fluid (CSF) of ocular syphilis patients to determine the co-occurrence of neurosyphilis. METHODS: This was a retrospective study of 17 patients (23 eyes) with ocular syphilis admitted to the Fifth People's Hospital, Suzhou, China from September 2017 to December 2021. Clinical manifestations, laboratory tests, treatment, and clinical outcomes were analyzed, and a review was conducted. RESULTS: Eight males (12 eyes) and nine females (11 eyes) were enrolled. Mean patient age was 49.06 ± 3.47 years. The total manifestation time for ocular symptoms ranged from 10 days to 6 years. The cohort was comprised of three cases of early syphilis, four cases of late syphilis, and ten cases of unknown stage. The primary complaints were decreased visual acuity in 15 cases (21 eyes), ptosis in 1 case (1 eye), and loss of light perception in 1 case (1 eye). Cases were diagnosed as chorioretinitis in 7 cases (8 eyes), optic nerve retinitis in 4 cases (6 eyes), optic neuritis in 4 cases (7 eyes), and oculomotor nerve palsy in 1 case (1 eye), syphilitic stromal keratitis in 1 case (1 eye). Serum HIV antibody was positive in one case(Nos.2). All patients had reactive serum Treponema Pallidum Particle Agglutination (TPPA) and Toluidine Red Unheated Serum Test (TRUST). All patients underwent CSF examination. CSF white blood cell count was ≥5 × 10(6)/L in 13 cases, CSF protein was >500 mg/L in 6 cases, TPPA was reactive in 15 cases, and TRUST was reactive in 5 cases. Eleven cases were also diagnosed with neurosyphilis. Patients were treated with either penicillin G sodium or ceftriaxone sodium. At time of discharge, 12 patients reported improved visual acuity. Abnormal serum or CSF examination improved in ten patients during the 6–12 month follow-up. CONCLUSION: Visual acuity loss is a warning indicator of ocular syphilis. Ocular syphilis primarily manifests as posterior uveitis, involving the choroid, retina, and optic nerve, and often co-occurs with neurosyphilis. Effective treatment should be administered immediately to avoid irreversible visual impairment and other serious adverse outcomes.
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spelling pubmed-96215972022-11-01 Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases Xu, Yating Li, Jingjing Xu, Yuxuan Xia, Wei Mo, Xingfan Feng, Mingzhi He, Fanghua Li, Shanshan Du, Fangzhi Wang, Qianqiu Wu, Minzhi Front Med (Lausanne) Medicine OBJECTIVES: To define the clinical features of ocular syphilis and analyze the cerebrospinal fluid (CSF) of ocular syphilis patients to determine the co-occurrence of neurosyphilis. METHODS: This was a retrospective study of 17 patients (23 eyes) with ocular syphilis admitted to the Fifth People's Hospital, Suzhou, China from September 2017 to December 2021. Clinical manifestations, laboratory tests, treatment, and clinical outcomes were analyzed, and a review was conducted. RESULTS: Eight males (12 eyes) and nine females (11 eyes) were enrolled. Mean patient age was 49.06 ± 3.47 years. The total manifestation time for ocular symptoms ranged from 10 days to 6 years. The cohort was comprised of three cases of early syphilis, four cases of late syphilis, and ten cases of unknown stage. The primary complaints were decreased visual acuity in 15 cases (21 eyes), ptosis in 1 case (1 eye), and loss of light perception in 1 case (1 eye). Cases were diagnosed as chorioretinitis in 7 cases (8 eyes), optic nerve retinitis in 4 cases (6 eyes), optic neuritis in 4 cases (7 eyes), and oculomotor nerve palsy in 1 case (1 eye), syphilitic stromal keratitis in 1 case (1 eye). Serum HIV antibody was positive in one case(Nos.2). All patients had reactive serum Treponema Pallidum Particle Agglutination (TPPA) and Toluidine Red Unheated Serum Test (TRUST). All patients underwent CSF examination. CSF white blood cell count was ≥5 × 10(6)/L in 13 cases, CSF protein was >500 mg/L in 6 cases, TPPA was reactive in 15 cases, and TRUST was reactive in 5 cases. Eleven cases were also diagnosed with neurosyphilis. Patients were treated with either penicillin G sodium or ceftriaxone sodium. At time of discharge, 12 patients reported improved visual acuity. Abnormal serum or CSF examination improved in ten patients during the 6–12 month follow-up. CONCLUSION: Visual acuity loss is a warning indicator of ocular syphilis. Ocular syphilis primarily manifests as posterior uveitis, involving the choroid, retina, and optic nerve, and often co-occurs with neurosyphilis. Effective treatment should be administered immediately to avoid irreversible visual impairment and other serious adverse outcomes. Frontiers Media S.A. 2022-10-17 /pmc/articles/PMC9621597/ /pubmed/36325386 http://dx.doi.org/10.3389/fmed.2022.1037712 Text en Copyright © 2022 Xu, Li, Xu, Xia, Mo, Feng, He, Li, Du, Wang and Wu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Xu, Yating
Li, Jingjing
Xu, Yuxuan
Xia, Wei
Mo, Xingfan
Feng, Mingzhi
He, Fanghua
Li, Shanshan
Du, Fangzhi
Wang, Qianqiu
Wu, Minzhi
Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases
title Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases
title_full Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases
title_fullStr Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases
title_full_unstemmed Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases
title_short Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases
title_sort case report: visual acuity loss as a warning sign of ocular syphilis: a retrospective analysis of 17 cases
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9621597/
https://www.ncbi.nlm.nih.gov/pubmed/36325386
http://dx.doi.org/10.3389/fmed.2022.1037712
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