De Simone Luca, Ceccarelli Francesca, Gentile Pietro, Bolletta Elena, Gozzi Fabrizio, Ferraro Vanessa, Romano Mario, Nucci Carlo, Cimino Luca
Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Ophthalmology Unit, Department of Experimental Medicine, Università di Roma "Tor Vergata", Rome, Italy.
Ocul Immunol Inflamm. 2025 Oct;33(8):1847-1851. doi: 10.1080/09273948.2025.2516082. Epub 2025 Jun 13.
Syphilis is a systemic sexually transmitted infection that often mimics autoimmune and neurological disorders, which can lead to diagnostic delays. We describe a series of four patients affected by ocular syphilis initially misdiagnosed as a systemic inflammatory condition to highlight the ophthalmologist's role in early detection and management, thereby preventing irreversible visual impairment.
We retrospectively reviewed four cases of ocular syphilis from 2022 to 2024, which were initially misdiagnosed as autoimmune or neurological diseases and thus inappropriately treated with immunosuppressive therapy. The patients underwent a full ophthalmic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, fundus imaging, optical coherence tomography, and retinal angiography. Syphilis serologies were performed, and treatment included intravenous penicillin G or ceftriaxone (for penicillin-allergic patients).
All patients tested positive for syphilis, with negative HIV screening. Initial misdiagnoses included systemic sarcoidosis, multiple sclerosis, psoriasis-like skin lesions, or unknown inflammatory conditions and were treated with unnecessary immunosuppressive therapy. Ocular findings varied from granulomatous panuveitis to retinal vasculitis, placoid chorioretinitis, and macular edema. Antibiotic therapy led to significant clinical improvement, but patients exhibited irreversible damage, such as decreased visual acuity, persistent color vision loss, retinal atrophy, and irreversible photoreceptor damage.
Syphilis remains a great mimicker, frequently misdiagnosed as non-infectious systemic disease. Ophthalmologists play a critical role in identifying ocular manifestations and initiating appropriate serological testing. A delayed diagnosis increases the risk of irreversible damage. Given the rising incidence, greater awareness and interdisciplinary collaboration are essential to ensure timely diagnosis and management.
梅毒是一种全身性性传播感染疾病，常表现出类似自身免疫性疾病和神经系统疾病的症状，这可能导致诊断延误。我们描述了一系列四名眼部梅毒患者，他们最初被误诊为全身性炎症性疾病，以强调眼科医生在早期检测和管理中的作用，从而防止不可逆的视力损害。
我们回顾性分析了2022年至2024年期间的四例眼部梅毒病例，这些病例最初被误诊为自身免疫性或神经系统疾病，因此接受了不适当的免疫抑制治疗。患者接受了全面的眼科检查，包括最佳矫正视力、裂隙灯生物显微镜检查、眼底成像、光学相干断层扫描和视网膜血管造影。进行了梅毒血清学检测，治疗包括静脉注射青霉素G或头孢曲松（对青霉素过敏的患者）。
所有患者梅毒检测呈阳性，HIV筛查呈阴性。最初的误诊包括全身性结节病、多发性硬化症、银屑病样皮肤病变或不明炎症性疾病，并接受了不必要的免疫抑制治疗。眼部表现从肉芽肿性全葡萄膜炎到视网膜血管炎、地图状脉络膜视网膜病变和黄斑水肿不等。抗生素治疗使临床症状有显著改善，但患者仍表现出不可逆的损害，如视力下降、持续的色觉丧失、视网膜萎缩和不可逆的光感受器损伤。
梅毒仍然是一种极易被误诊的疾病，经常被误诊为非感染性全身性疾病。眼科医生在识别眼部表现和启动适当的血清学检测方面起着关键作用。诊断延迟会增加不可逆损害的风险。鉴于发病率不断上升，提高认识和跨学科合作对于确保及时诊断和管理至关重要。
