Gonzalez Collazo Monica P, Rebollo Rodriguez Nicole P, Santiago-Vazquez Marely, Crespo-Ramos Susanne M, Marcos-Martinez Maria J, Villegas Víctor M, Oliver Armando L
University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA.
University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Dermatology, San Juan, PR, USA.
Am J Ophthalmol Case Rep. 2020 Dec 31;21:101007. doi: 10.1016/j.ajoc.2020.101007. eCollection 2021 Mar.
To report an atypical bilateral hypopyon presentation of syphilitic uveitis.
A 38-year-old male presented with a 2-day history of bilateral progressive visual loss, conjunctival hyperemia, and photophobia. Initial ophthalmologic examination revealed bilateral hypopyon and vitritis that limited the examination of the posterior segment. The physical exam revealed cervical lymphadenopathy, glossal leukoplakia, erythematous maculae on the hard palate, erythematous macular lesions on both palms, onychodystrophy, onycholysis, and psoriasiform plaques on both plantar surfaces, testicular tenderness, and hypopigmented patches on the scrotal and perianal skin. A therapeutic and diagnostic vitrectomy was performed on the right eye, and the intraoperative findings were consistent with severe vitritis and pre-retinal precipitates. The cytopathologic analysis of the right vitreous revealed a mixed inflammatory process composed of lymphocytes, histiocytes, and neutrophils in a proteinaceous background. Laboratory testing revealed positive serum RPR, CSF FTA-Abs and VDRL, and HIV serology. Treatment with a 2-week course of intravenous penicillin G 4 million units every 4 hours and topical corticosteroids resulted in complete resolution of the uveitis.
Bilateral hypopyon uveitis may be a rare presentation of syphilitic uveitis. As with most forms of uveitis, syphilis should be considered in the differential diagnosis of patients presenting with bilateral hypopyon.
报告一例梅毒葡萄膜炎的非典型双侧前房积脓表现。
一名38岁男性，有2天双侧进行性视力丧失、结膜充血和畏光病史。初次眼科检查发现双侧前房积脓和玻璃体炎，限制了对眼后段的检查。体格检查发现颈部淋巴结肿大、舌白斑、硬腭红斑、双手掌红斑性黄斑病变、甲营养不良、甲剥离以及双足底银屑病样斑块、睾丸压痛，阴囊和肛周皮肤色素减退斑。对右眼进行了治疗性和诊断性玻璃体切除术，术中发现与严重玻璃体炎和视网膜前沉着物一致。右玻璃体的细胞病理学分析显示在蛋白质背景中由淋巴细胞、组织细胞和中性粒细胞组成的混合性炎症过程。实验室检查显示血清快速血浆反应素试验（RPR）、脑脊液荧光螺旋体抗体吸收试验（FTA-Abs）和性病研究实验室试验（VDRL）阳性，以及HIV血清学检查阳性。给予每4小时静脉注射400万单位青霉素G为期2周的疗程以及局部使用皮质类固醇治疗后，葡萄膜炎完全消退。
双侧前房积脓性葡萄膜炎可能是梅毒葡萄膜炎的一种罕见表现。与大多数葡萄膜炎形式一样，在双侧前房积脓患者的鉴别诊断中应考虑梅毒。
