A 57-year-old immunocompetent woman presented to the emergency department with ocular discomfort and bilateral vision abnormalities.
Visual acuity (VA) was 0.125 in the right eye (OD) and 0.2 in the left eye (LE).
In the Biomicry, a fold with endothelial folds and posterior synechiae in both eyes (AO), 1+ cells of anterior chamber (AC) intensity was observed.
Ocular tension was normal in BE.
Bilateral severe colitis was observed in the eye fundus, suggesting the presence of vasculitis.
Topical treatment with dexamethasone eye drops, trobramycin and atropine was initiated.
At 48 hours, vision decreased to movement of the hands in OA with more intense arthritis.
The patient was hospitalized and treated with topical dexamethasone (90 drops regimen), intravenous methylprednisolone (40 mg every 12 h) and ciprofloxacin (200 mg every 12 h).
A slight improvement at 7 days in inflammation of the anterior pole and rupture of synechiae allowed a better view of the FO, observing vitreous turbidity and foci of chorioretinitis in the posterior pole.
1.
Infectious serology was positive for syphilis, TPHA + (1/320) without other analytical findings.
Imaging tests, cranial and orbital nuclear magnetic resonance and chest X-ray showed no abnormalities.
In the more detailed anamnesis the patient reports a gynecological infection that could be compatible with syphilitic chancro 35 years ago.
Due to the possibility of neurological syphilis, it was decided to puncture CSF that reported it as normal.
After repeating serology, TPHA + (1/640) with Total Ac + for Lues, it was decided to treat with Penicillin G Benzathine 2.4 million I.U. intramuscular corticosteroids every week for 3 weeks.
The clinical course was favorable, improving visual acuity to 0.1 in RE and 0.3 in LE after the first injection.
VA continued to improve although with significant involvement of the visual field (VC) with decreased general and bilateral sensitivity.
In subsequent revisions the foci of chorioretinitis were better observed, leaving hyperfluorescent areas in early times in the fluorescein acidic angiography (GFA), which are maintained in later stages with fibrofluorescence.
1.
At 3 months VA in RE was 0.8 and unit in OI remained equal to 6, 12 and 24 months of evolution, with foci of observarium and retinol in VC without signs of normal activity.
