Jäger S, Meier F M
Augenklinik, Universitätsspital Zürich, Zürich, Schweiz.
Klin Monbl Augenheilkd. 2011 Apr;228(4):330-3. doi: 10.1055/s-0031-1273229. Epub 2011 Apr 11.
In spite of the worldwide declining number of syphilis cases, there has been stable rate of syphilis infections in Switzerland from 2006 - 2008. In the year 2008 672 case were reported. Uveitis is the most common ocular finding in syphilis. It occurs in 2.5 %-5 % of all cases.
Six patients (5 male, mean age 44.2 years, 1 female, age 41 year) who were examined in our facility from April 2007 to October 2009. All patients presented with posterior uveitis, with a multitude of clinical signs. All patients tested positive for syphilis-specific serologic testing (VDRL, TPPA, FTA-ABS test). One patient was initially tested negative. 5 patients showed a weakly positive VDRL and FTA-ABS test in the cerebrospinal fluid, one patient tested clearly positive.
5 patients were treated with i. v. penicillin G (4 Mio. units every 4 hours). Under treatment the intraocular inflammation resolved in all patients. There was a considerable rise in visual acuity for all patients.
Syphilis is a persisting problem in Switzerland. All patients belonged to a risk population. In addition 5 patients tested positive for HIV. A precise case history is therefore mandatory for an early diagnosis, that presents with diverse clinical signs. This case series shows furthermore the efficacy of the antibiotic treatment. Ophthalmologists can play an important role in the diagnosis and management of this severe disease.
