Liu I-Hsien, Chen Shih-Jen, Chung Yu-Mei, Chiou Shih-Hwa, Wong Wing-Wai
Department of Ophthalmology, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
J Formos Med Assoc. 2002 Sep;101(9):642-5.
Syphilis is an uncommon cause of uveitis in HIV-infected patients. We report a case of bilateral panuveitis and describe its characteristics as the initial manifestation of HIV infection. A 74-year-old heterosexual male complained of blurred vision and floaters in both eyes for 40 days. Slit lamp examination showed diffuse keratic precipitates and cells in the anterior chamber of both eyes. Fundus examination revealed multiple small white dots and scattered retinal hemorrhage over the mid-equatorial retina with marked vitritis. Physical examination disclosed multiple erythematous papules over bilateral palms compatible with secondary syphilis. Serologic tests--the venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-ABS) test, and Treponema pallidum hemagglutination (TPHA) test--were all positive. Aqueous fluid also showed positive FTA-ABS reaction. Under the impression of acquired secondary syphilis, enzyme-linked immunosorbent assay and Western blot test were performed and revealed concurrent HIV infection. After intravenous administration of penicillin-G, 18 million units daily for 2 weeks, the vitritis and retinochoroiditis improved. All patients with panuveitis of unknown cause should undergo VDRL and FTA-ABS screening. Subsequent testing for HIV antibody in leutic uveitis is also mandatory.
梅毒是HIV感染患者葡萄膜炎的罕见病因。我们报告一例双侧全葡萄膜炎病例，并将其特征描述为HIV感染的初始表现。一名74岁的异性恋男性主诉双眼视力模糊和飞蚊症40天。裂隙灯检查显示双眼前房有弥漫性角膜后沉着物和细胞。眼底检查发现赤道中部视网膜有多个小白点和散在的视网膜出血，伴有明显的玻璃体炎。体格检查发现双侧手掌有多个红斑丘疹，符合二期梅毒表现。血清学检查——性病研究实验室（VDRL）试验、荧光密螺旋体抗体吸收（FTA-ABS）试验和梅毒螺旋体血凝（TPHA）试验——均为阳性。房水FTA-ABS反应也呈阳性。在获得性二期梅毒的诊断印象下，进行了酶联免疫吸附试验和蛋白质印迹试验，结果显示同时感染了HIV。静脉注射青霉素G，每日1800万单位，持续2周后，玻璃体炎和视网膜脉络膜炎有所改善。所有不明原因的全葡萄膜炎患者均应接受VDRL和FTA-ABS筛查。对于梅毒性葡萄膜炎患者，后续进行HIV抗体检测也是必要的。
