Syphilitic Uveitis: Clinical Features, Treatment, and Outcome

BACKGROUND Syphilis is a sexually transmitted infection in which ocular involvement is relatively uncommon. This report describes the clinical presentation, treatment, and visual outcome of a patient with syphilitic uveitis. CASE REPORT A 52-year-old man with a history of sexual promiscuity was diagnosed with bilateral panuveitis secondary to syphilis. He experienced progressively worsening bilateral vision loss over 1 month. The diagnosis was confirmed by serological positivity for Treponema pallidum. The patient displayed human immunodeficiency virus negativity. At presentation, visual acuity in the right eye was light perception and projection; in the left eye, it was 20/630. Ophthalmologic examination revealed non-granulomatous panuveitis, vitritis, chorioretinitis, retinal vasculitis, and papillitis. The patient was treated with intravenous aqueous penicillin G and systemic methylprednisolone for 7 days, followed by 5 weekly applications of intramuscular benzathine penicillin G. Topical therapy included antibiotic-corticosteroid, atropine sulfate, and bromfenac eye drops in both eyes. Two months after initiation of therapy, a periocular injection of methylprednisolone was administered to the right eye. Substantial improvement was observed, with final visual acuity of VOD=20/25 and VOS=20/20 after approximately 14 weeks of follow-up. CONCLUSIONS Ocular syphilis exhibits wide clinical variability. In this case, it manifested as non-granulomatous panuveitis with inflammation of the retinal vessels and optic disc. Early serologic diagnosis and prompt treatment are essential for favorable outcomes. Final visual acuity improved after systemic antibiotic and corticosteroid therapy, complemented by topical antibiotic-corticosteroid agents, cycloplegic drops, and a nonsteroidal anti-inflammatory agent.