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Syphilitic Chorioretinitis


Presentation

  • Our patient was treated with oral corticosteroids prior to presentation.[healio.com]
  • The colour vision and visual fields continued to be markedly impaired when she was lost to follow-up 2 months after presentation. Case 2 A 40-year-old homosexual man presented with a painless reduction of vision in his right eye.[nature.com]
  • We present an untreated patient with complete spontaneous resolution of ASPPC.[egms.de]
  • The clinical presentations of ocular syphilitic chorioretinitis include uveitis, optic neuritis, and nonnecrotizing retinitis. Patients may also experience dermatologic and CNS symptoms.[aao.org]
  • In the series by Pichi and colleagues, subretinal fluid was noted only in patients who had imaging done within the first 2 days of presentation; images from 1 week after presentation and later failed to demonstrate any subretinal fluid[ 10 ].[joii-journal.springeropen.com]
Severe Pain
  • She also reported several painful ulcers on her tongue and inside of her lower lip and a sore throat. Fig. 4.[reviewofoptometry.com]
Ankle Edema
  • Three months prior to admission the patient suffered from bronchitis, accompanied by puffiness and ankle edema, presumably due to nephrotic range proteinuria, and arthralgias.[link.springer.com]
Inguinal Lymphadenopathy
  • General physical examination revealed laryngitis, bilateral shotty inguinal lymphadenopathy, and multiple chronic ulcers on the right leg secondary to intravenous drug abuse.[nature.com]
Sore Throat
  • Before this she had a 3-week history of sore throat and hoarseness of voice. She was a known intravenous drug abuser and smoker. Further questioning revealed a history of being sexually assaulted 6 months before presentation.[nature.com]
  • She also reported several painful ulcers on her tongue and inside of her lower lip and a sore throat. Fig. 4.[reviewofoptometry.com]
Palmar Erythema
  • ., palmar erythema, hair loss) could be interpreted as medication-induced complications.[link.springer.com]
Purpura
  • Henoch-Schönlein purpura can also have a clinical appearance similar to acute hemorrhagic edema of childhood, but the latter occurs in children between the ages of 4 months and 2 years, has no systemic features, and resolves in 1-3 weeks without sequelae[books.google.de]
Enlarged Blind Spot
  • blind spot; ERG: depressed A-wave, recovers during resolution of the disease None VKH Syndrome Nonrhegmatogenous retinal detachments, often with deep, gray choroidal spots; patients often note tinnitus or severe headaches FA: diffuse, pinpoint hyperfluorescent[reviewofoptometry.com]
Neck Pain
  • Her medical history was significant for post-traumatic stress disorder, anxiety, chronic neck pain, gestational diabetes and gastroesophageal reflux disease. Her medications included methocarbamol, omeprazole, oxybutynin chloride and venlafaxine.[reviewofoptometry.com]
Mydriasis
  • Seite 358 - Ocular signs of cerebral involvement include the following: nystagmus, unilateral mydriasis, bilateral miosis with slow response to light, paralysis of accommodation, convergence, and 3rd, 4th, and 6th cranial nerve involvement. ‎[books.google.de]
Urethral Discharge
  • There was no history of urethral discharge. Over the last 2 weeks he had also developed painful mouth ulcers. There was no history of intravenous drug usage. On examination, visual acuity was 6/60 OD, 6/9 OS.[nature.com]

Workup

  • A case report illustrates the importance of performing a systemic workup on all patients with posterior uveitis. By Nora Muakkassa, MD, and Lana Rifkin, MD ; edited by Heeral R. Shah, MD, and Jordana G.[retinatoday.com]
  • The patient’s history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR) and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis.[westjem.com]
  • It is important to differentiate fungal and bacterial causes of endophthalmitis and systemic status of the patient including blood cultures and workup, and patient risk factors, such as bacterial septicemia from wound infections, endocarditis, liver abscess[retinalphysician.com]

Treatment

  • […] patients remain serofast after treatment with stable titers for life. 33,34 Treatment of patients who are severely allergic to penicillin involves an alternative agent such as the tetracyclines or ceftriaxone.[reviewofoptometry.com]
  • Nevertheless, even if the inflammation showed signs of spontaneous improvement, it subsided completely only after antimicrobial treatment.[egms.de]
  • The standard treatment for neurosyphilis, intravenous penicillin G, was initiated in all patients within 10 to 14 days of presentation. Post-treatment OCT displayed restoration of the ellipsoid and RPE layers in nearly all patients.[healio.com]
  • With treatment of his neurosyphillis his vision improved from 20/63 to 20/32.[retinagallery.com]
  • 276 1552 Symptomatic Treatment 277 156 Differential Diagnosis 278 1563 Congenital Fibrosis of the Extraocular Muscles 279 Treatment of Specific Types of Nystagmus 283 161 Introduction 284 16211 Etiology 286 16212 Therapeutic Recommendations 287 1622[books.google.com]

Prognosis

  • Ischemic Visual Loss 235 1335 Orbital Manifestations 236 1343 LargeVessel Vasculitis 237 135 Laboratory Investigations in GCA 238 1352 CReactive Protein 239 1355 Anemia 240 1361 Temporal Artery Biopsy 241 1363 Role of Ultrasound 243 137 Treatment and Prognosis[books.google.com]
  • Misdiagnosis as AION could lead to steroid therapy without antibiotics, which can worsen prognosis.[e-sciencecentral.org]
  • Nevertheless, a UK survey of children with toxoplasmic retinochoroiditis found that, overall, the visual prognosis was good. [ 16 ][patient.info]
  • Prognosis The prognosis for patients with retinal vasculitis is variable, reflecting the heterogenous nature of this group of disorders. References: Graham E, Spalton DJ, Sanders MD: Immunological investigations in retinal vasculitis.[eophtha.com]
  • Endogenous endophthalmitis: diagnosis, management, and prognosis. J Ophthalmic Inflamm Infect. 2015;5(1):32. Sugita S, Kamoi K, Ogawa M, Watanabe K, Shimizu N, Mochizuki M.[retinalphysician.com]

Etiology

  • 274 1541 Myohistological Investigations 275 155 Treatment 276 1552 Symptomatic Treatment 277 156 Differential Diagnosis 278 1563 Congenital Fibrosis of the Extraocular Muscles 279 Treatment of Specific Types of Nystagmus 283 161 Introduction 284 16211 Etiology[books.google.com]
  • Based upon the FAF, FA and OCT results, the retinal specialist who completed the FA was concerned about the unknown etiology of the posterior uveitis.[reviewofoptometry.com]
  • Pathology Etiology various congenital infections such as 2,3 rubella: ocular rubella cytomegalovirus: ocular cytomegalovirus toxoplasmosis: ocular toxoplasmosis as a ocular manifestation of tuberculosis syphilis : syphilitic posterior placoid chorioretinitis[radiopaedia.org]
  • Anterior uveitis (iritis, iridocyclitis), is primarily due to rheumatologic and idiopathic etiologies with herpes being the most common infectious cause.[westjem.com]
  • Epidemiology U.S. incidence dropped through 2000 but has risen since with more cases in men having sex with men Etiology Caused by Treponema pallidum, subspecies pallidum, a microaerophilic spirochete that is pathogenic only to humans Clinical features[pathologyoutlines.com]

Epidemiology

  • A systematic review of the epidemiologic interactions between classic STD and HIV: how much is really known. Sex Transm Dis. 2001;28:579-597. 18. Sperling L. Syphilitic Alopecia.[westjem.com]
  • Epidemiology U.S. incidence dropped through 2000 but has risen since with more cases in men having sex with men Etiology Caused by Treponema pallidum, subspecies pallidum, a microaerophilic spirochete that is pathogenic only to humans Clinical features[pathologyoutlines.com]
  • Today, the knowledge of even rare manifestations of the disease and the awareness of its increasing epidemiological relevance remain the key requirement for a correct and rapid diagnosis of Treponema pallidum infections by physicians.[link.springer.com]
  • JET is a professor of Ophthalmology and Epidemiology. JPD is an associate professor of Ophthalmology. BMB, NJB, and TGL are assistant professors of Ophthalmology. TAO is a Uveitis Fellow.[joii-journal.springeropen.com]
  • Non-infective causes are also infrequent with few epidemiological data available.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of ASPPC is not completely understood.[joii-journal.springeropen.com]
  • By better understanding the response to infectious agents, we could learn about our immune system, his defense mechanisms and the pathophysiology of infectious diseases.[egms.de]
  • The pathophysiology of ASPPC is not well understood, but recent studies of FAF and mfERG findings indicate choroidal and RPE inflammation with significant, often long-lasting, disruption of the photoreceptors.[reviewofoptometry.com]
  • These include rickettsiosis, Rift Valley fever, dengue fever, and Chikungunya virus. [7] Pathophysiology Chorioretinitis affects the uveal tract, which consists of the iris, ciliary body, and choroid.[emedicine.medscape.com]
  • Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol 1987; 103:527-36. 61. Holland GN, Sakamoto MJ, Hardy D, Sidikaro Y, Kreiger AE, Frenkel LM.[hivinsite.ucsf.edu]

Prevention

  • Encyclopedia) RPR test (Medical Encyclopedia) Syphilis (Centers for Disease Control and Prevention) Syphilis - primary (Medical Encyclopedia) Syphilis and MSM (Men Who Have Sex with Men) (Centers for Disease Control and Prevention) VDRL test (Medical[icdlist.com]
  • Workowski KA , Berman S , Centers for Disease Control and Prevention (CDC) . MMWR Recomm Rep . 2010 ; 59 ( RR-12 ): 1 - 110 . Congenital Syphilis—United States, 2003-2008. Centers for Disease Control and Prevention (CDC) .[pedsinreview.aappublications.org]
  • In March 2016, the Centers for Disease Control and Prevention (CDC) issued a clinical advisory for ocular syphilis due to a 12-case cluster reported in San Francisco and Seattle over four months. 1 Although ocular involvement from syphilis is rare, increasing[reviewofoptometry.com]
  • The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. There is a paucity of emergency medicine literature on ocular syphilis.[westjem.com]
  • Syphilis and human immunodeficiency virus: prevention and politics. Arch Neurol. 2004;61(10):1505-1508. Chesson HW, Pinkerton SD, Irwin KL, Rein D, Kassler WJ.[retinalphysician.com]

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