Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Retin Cases Brief Rep. 2023 Jan 1;17(1):9-12. doi: 10.1097/ICB.0000000000001106.
To report a case of syphilitic outer retinopathy revealed after progression to panuveitis after a course of oral steroids for suspected poison ivy.
Retrospective case report.
A 44-year-old diabetic man presented with progressive symptoms of nyctalopia and color vision changes associated with outer retinal disruption on macular imaging but minimal evidence of intraocular inflammation on examination. A short course of oral steroids for an unrelated skin condition induced rapid progression to frank panuveitis with retinal vascular sheathing and retinal whitening. Systemic workup identified syphilis as the etiology. The patient's visual symptoms and disruption of the photoreceptor and retinal pigment epithelial layers on OCT improved after treatment with IV penicillin.
Syphilitic outer retinopathy represents an unusual manifestation of ocular syphilis that can present with minimal examination findings. We present here a case of oral steroid use resulting in the progression of syphilitic outer retinopathy to a more fulminant form of syphilitic uveitis that ultimately revealed the correct diagnosis and prompted the correct intervention. This case highlights the importance of maintaining a high level of suspicion for this treatable condition.
报告 1 例梅毒性外视网膜病变病例，该患者在疑似毒葛性皮炎使用口服类固醇治疗后进展为全葡萄膜炎。
回顾性病例报告。
1 例 44 岁糖尿病男性，因与眼底外层破坏相关的进行性暗视力和色觉改变以及检查时眼内炎症证据极少而就诊。由于无关的皮肤疾病，患者使用了短疗程的口服类固醇，随后迅速进展为典型的全葡萄膜炎，伴有视网膜血管鞘和视网膜变白。全身性检查发现梅毒是病因。患者的视觉症状和光感受器和视网膜色素上皮层在 OCT 上的破坏在接受 IV 青霉素治疗后得到改善。
梅毒性外视网膜病变是眼部梅毒的一种不常见表现，可能表现为检查结果极少。我们在此介绍 1 例因使用口服类固醇而导致梅毒性外视网膜病变进展为更严重形式的梅毒性葡萄膜炎的病例，最终揭示了正确的诊断并促使进行了正确的干预。该病例强调了对这种可治疗疾病保持高度怀疑的重要性。
