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Acute progressive visual loss related to intraocular inflammation. The return of the 'great imitator'

Poster Details

First Author: E.Kanonidou GREECE

Co Author(s):    E. Kanonidou   P. Kikas   I. Salonikou   A. Alexandrakis   G. Sakkias      0   0 0   0 0   0 0   0 0

Abstract Details



Purpose:

To present a case of acute, progressive visual loss in a patient related to syphilitic intraocular inflammation and to highlight the return of the ‘great imitator’ as a cause for the management of similar cases.

Setting:

Department of Ophthalmology, ‘’Hippokrateion’’General Hospital of Thessaloniki, Thessaloniki, Greece

Methods:

Male patient, age 45 years, was referred from an ophthalmologist in private practice with the diagnosis of acute retinal necrosis related to cytomegalovirous. He mentioned acute, progressive visual loss of the left eye for the last 10 days and no significant past medical history. From the ophthalmological examination: ΒCVA RE: 10/10, BCVA LE:CF (30cm), anterior uveitis (hypopyon) /posterior uveitis (vitritis) and multiple retinitis foci. Laboratory examinations (IgG, IgM CMV, HSV, VZV, Toxo, HIV, ANA, ANCA, RF) were ordered and the patients was admitted to the hospital and treatment with IV acyclovir and methylprednisolone was started.

Results:

There was a reduction of the retinitis foci number, the hypopyon was diminished and the visual acuity of the LE was improved to 1/10. After the day 10, there was a deterioration of the visual acuity accompanied by increase in number of retinitis foci and symptoms and signs of the other eye. Treatment with corticosteroids was stopped, laboratory tests for syphilis diagnosis (RPR, VDRL, FTAabs) were ordered (which were positive) and treatment with IV penicillin G was initiated with subsequent improvement.

Conclusions:

Syphilis serolgy is mandatory in all patients presenting with unexplained intraocular inflammation. It is an inexpensive and reliable tool to unmask the great imitator. Syphilitic intraocular inflammation has excellent prognosis with early and adequate treatment.

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