Nonaka Kyosuke, Takahashi Yohei, Hasegawa Taiji, Iida Tomohiro
Ophthalmology, Tokyo Women's Medical University, Tokyo, JPN.
Cureus. 2024 Oct 28;16(10):e72534. doi: 10.7759/cureus.72534. eCollection 2024 Oct.
Syphilis has been increasing in adult infections in recent years, and ocular syphilis includes not only uveitis but also a variety of optic nerve and retinal lesions. We report a case of syphilis that caused unilateral optic papillitis and outer retinopathy complicated by diabetic retinopathy and improved with antibiotic treatment. The patient was a 61-year-old woman. During follow-up after vitreous surgery for proliferative diabetic retinopathy, her left visual acuity had decreased, fundus examination revealed redness and swelling of the left optic disc, and a visual field test revealed a central scotoma. Fluorescein angiography (FA) revealed leakage from the optic disc, and magnetic resonance imaging (MRI) revealed high signal intensity and contrast enhancement in the left optic nerve. No signs of uveitis, and the patient was diagnosed with optic neuritis and one course of steroid pulse therapy was performed. Due to improvement of the left optic disc swelling and MRI contrast enhancement, the oral steroids were gradually tapered and discontinued after about one month due to improvement in left optic disc swelling and MRI contrast enhancement. Meanwhile, blood tests during steroid administration revealed quantitative positive syphilis lipid antibodies and treponemal antibodies, and optical coherence tomography (OCT) revealed disruption in the left ellipsoid zone. Early acquired syphilis was diagnosed, and oral penicillin antibiotics were started. Five weeks after starting antibiotics, the outer retinal disruption showed signs of improvement. Ocular syphilis presents with characteristic retinal disorders, but in cases where the onset is optic disc edema, early diagnosis is difficult, and careful differentiation is required.
近年来，梅毒在成人感染中呈上升趋势，眼部梅毒不仅包括葡萄膜炎，还包括各种视神经和视网膜病变。我们报告一例梅毒病例，该病例导致单侧视神经乳头炎和视网膜外层病变，并伴有糖尿病性视网膜病变，经抗生素治疗后病情好转。患者为一名61岁女性。在接受增殖性糖尿病视网膜病变玻璃体手术后的随访期间，她的左眼视力下降，眼底检查显示左眼视盘红肿，视野检查显示中心暗点。荧光素血管造影（FA）显示视盘渗漏，磁共振成像（MRI）显示左侧视神经高信号强度和对比增强。无葡萄膜炎体征，患者被诊断为视神经炎，并进行了一个疗程的类固醇脉冲治疗。由于左眼视盘肿胀和MRI对比增强有所改善，口服类固醇逐渐减量，并在约一个月后因左眼视盘肿胀和MRI对比增强改善而停药。与此同时，类固醇给药期间的血液检查显示梅毒脂质抗体和梅毒螺旋体抗体定量呈阳性，光学相干断层扫描（OCT）显示左侧椭圆体带中断。诊断为早期获得性梅毒，并开始口服青霉素抗生素治疗。开始使用抗生素五周后，视网膜外层破坏有改善迹象。眼部梅毒表现为特征性视网膜病变，但在以视盘水肿起病的病例中，早期诊断困难，需要仔细鉴别。
