Published date: Nov 30 2023

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: Oct–Dec 2023, Volume 18, Issue 4

Pages: 452–457

DOI: 10.18502/jovr.v18i4.14559

Sahba Fekri

Shahram Salehi-Rad

Hosein Nouri - Hosein.Nouri.2018@gmail.com

Shabnam Tehrani

Bita Shalbafan

Seyed-Hossein Abtahi

Purpose: To report the first case of ocular syphilis in an Iranian patient and discuss its diagnostic challenges.
Case Report: A man in his mid-70s presented with progressive bilateral visual and auditory decline. He had previously lived in a Southeast Asian country for 10 years. Prior steroid therapies entailed no inflammation subsidence. His visual acuity at presentation was light perception OU. Funduscopic findings included severe vitritis, severe optic atrophy, diffuse retinal vascular occlusion, and diffuse retinal atrophy OU. Angiography demonstrated diffuse areas of retinal and choriocapillaris atrophy with no active choroiditis. Scaly cutaneous lesions were noted on his palms and soles – atypical findings of secondary syphilis. Serum analysis revealed an underlying syphilis infection. The cerebrospinal fluid sample was reactive to anti-syphilis antibodies, securing a neurosyphilis diagnosis. Two weeks of antibiotic therapy resulted in cutaneous lesions resolution and relative visual improvement despite extensive baseline retinal atrophic damage.
Conclusion: Ocular syphilis can mimic numerous ocular inflammatory scenarios. In cases of ocular inflammation that is unresponsive to steroids, reconsidering alternative diagnoses, especially infections with the highest clinical relevance, is necessary. We stress the importance of acquiring patients’ sexual history, regardless of cultural barriers and the rarity of the entity in some regions.

1. Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019;97:548-562.

2. Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, et al. Ocular syphilis. Surv Ophthalmol 2021.

3. Oliver SE, Aubin M, Atwell L, Matthias J, Cope A, Mobley V, et al. Ocular Syphilis — Eight Jurisdictions, United States, 2014–2015. MMWR Morb Mortal Wkly Rep. 2016 ;65:1185– 8.

4. Dutta Majumder P, Chen EJ, Shah J, Ching Wen Ho D, Biswas J, See Yin L, et al. Ocular Syphilis: An Update. Ocul Immunol Inflamm. 2019;27:117–125.

5. Moradi A, Salek S, Daniel E, Gangaputra S, Ostheimer TA, Burkholder BM, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients With Ocular Syphilis. Am J Ophthalmol. 2015;159:334-343.e1.

6. Janghorban R, Azarkish F. An overview on sexually transmitted infections in Iran. Int J Reprod Contraception, Obstet Gynecol. 2016;585–595.

8. Gonzalez H, Koralnik IJ, Marra CM. Neurosyphilis. Semin Neurol. 2019;39:448–455.

9. Grimaux X, Ayoubi R El, Clec’h C Le. An unusual giant serpiginous lesion of secondary syphilis. An Bras Dermatol 2018;93:590–591.