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ABSTRACT
Ocular and systemic syphilis are well known to mimic other clinical entities making them challenging to diagnose in many cases. Syphilis testing plays an important role in diagnosis and timely treatment. Here we describe a patient with untreated human immunodeficiency virus (HIV) infection who presented with bilateral panuveitis with repeatedly negative syphilis serologies. In light of worsening retinitis while on aggressive anti-viral treatment and in consideration of the clinical suspicion for syphilitic uveitis, intravenous penicillin was initiated empirically. The patient demonstrated significant improvement subjectively and objectively after treatment. We also review and discuss syphilis testing reliability generally and in HIV co-infected patients in particular. Empiric intravenous penicillin should be considered in patients with clinical features of ocular syphilis despite negative serologic testing, especially in those with HIV co-infection.
List of abbreviations
| AC | = | Anterior chamber |
| CSF | = | Cerebrospinal fluid |
| CIA | = | Chemiluminescence immunoassay |
| CMIA | = | Chemiluminescent microparticle immunoassay |
| CMV | = | Cytomegalovirus |
| DFA-TP | = | Direct fluorescent antibody test |
| DFM | = | Direct tests include dark-field microscopy |
| EZ | = | Ellipsoid zone |
| EIA | = | Enzyme immunoassay |
| FA | = | Fluorescein angiography |
| FTA-ABS | = | Fluorescent treponemal antibody |
| HSV | = | Herpes simplex virus |
| HIV | = | Human immunodeficiency virus |
| ILM | = | Internal limiting membrane |
| IM | = | Intramuscular |
| IV | = | Intravenous |
| MHA-TP | = | Microhemagglutination assay for Treponema pallidum antibodies |
| MFIA | = | Multiplex flow immunoassay |
| NTT | = | Non-treponemal test |
| OCT | = | Optical coherence tomography |
| PCR | = | Polymerase chain reaction |
| RPR | = | Rapid plasma reagin |
| RPE | = | Retinal pigment epithelium |
| SU, | = | Syphilitic uveitis |
| TPHA | = | Treponema pallidum hemagglutination assay |
| TPPA | = | Treponema pallidum particle agglutination |
| TT | = | Treponemal test |
| TRUST | = | Toluidine red unheated serum test |
| USR | = | Unheated serum reagin |
| VZV | = | Varicella zoster virus |
| VDRL | = | Venereal disease research laboratory |
Authors’ contributions
MG was a major contributor in writing the manuscript.
JA was a major contributor in writing the manuscript and was involved in the care provided to the patient described in this case.
SD was a major contributor in writing the manuscript.
NS was a major contributor in writing the manuscript.
SN was a major contributor in writing the manuscript and was the primary provider for the patient described in this case.
Disclosure statement
No potential conflict of interest was reported by the author(s).