Gutierrez B, Gayet S, Bertolino J, Jean E, Le Goff L, Voisin H, Sampo M, Meunier B, Harle J-R, Ebbo M, Schleinitz N, Menard A, Bernit E
Service de medecine interne, CHU limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
Service de gériatrie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France.
Rev Med Interne. 2020 Mar;41(3):160-167. doi: 10.1016/j.revmed.2019.06.006. Epub 2019 Jul 10.
Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017.
This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected.
Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases.
Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.
梅毒是一种性传播疾病。所有器官都可能受累，但眼部梅毒仅发生于0.6%的患者中。我们收集了2017年在马赛大学医院中心（UHC）需住院治疗的所有眼部梅毒病例。
这是一项回顾性单中心研究。眼部梅毒的诊断基于眼部炎症与梅毒血清学阳性结果相结合。对于每位患者，收集其性别、年龄、HIV感染状况、眼部和眼外症状、初始视力、梅毒血清学、脑脊液（CSF）分析（若进行）、治疗及临床反应。
共12名患者住院，年龄在28至86岁之间，其中男性10名，女性2名。2名患者HIV阳性。眼科病变具有异质性，后部结构受累最为严重。1例患者单独出现前葡萄膜炎。5例患者有眼外体征，伴有皮肤和/或黏膜受累。无患者出现神经症状。通过脑脊液分析确诊神经梅毒1例，疑似5例，排除2例。6例患者接受青霉素G治疗，6例接受头孢曲松治疗。所有病例视力均有改善。
在法国，眼部梅毒病例在过去几年中变得更为常见。即使没有有利的临床表现或既往史，在眼部炎症病例中也应怀疑该病。应系统筛查HIV合并感染。我们的研究表明，头孢曲松仍然是青霉素G的有效替代药物。
