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Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 219-220

A rare case of papilledema with subretinal fluid and intraretinal precipitates in a case of syphilis


1 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Ophthalmology, Ocular Pathology, Uveitis and Neuro Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission29-Jul-2022
Date of Acceptance07-Nov-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Madhusmita Mahapatra
Sri Sankaradeva Nethralaya, 96 Basistha Road, Beltola, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1692_22

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  Abstract 


Keywords: Intraretinal precipitates, ocular syphilis, papilledema, syphilis, vision loss


How to cite this article:
Mahapatra M, Das D, Bhattacharjee H, Ahir A, Rehman O. A rare case of papilledema with subretinal fluid and intraretinal precipitates in a case of syphilis. Indian J Ophthalmol Case Rep 2023;3:219-20

How to cite this URL:
Mahapatra M, Das D, Bhattacharjee H, Ahir A, Rehman O. A rare case of papilledema with subretinal fluid and intraretinal precipitates in a case of syphilis. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:219-20. Available from: https://www.ijoreports.in/text.asp?2023/3/1/219/368159



Ocular syphilis is also known as “the great masquerader” because of its wide variety of presentations.[1] Diagnosing a case of ocular syphilis is associated with a combination of symptoms and signs verified by laboratory studies.[1]

A 52-year-old male presented with blurring of vision, watering, and pain in both eyes (OU) for three months. On presentation, his visual acuity was 20/200, N18 in the right eye (OD), and 20/80, N18 in the left eye (OS). Slit-lamp biomicroscopy revealed immature cataract with a quiet anterior chamber (OU). Dilated fundus examination showed clear media with bilateral hyperemic and edematous optic disc, blurring of disc margins, peripapillary hemorrhages, cotton wool spots, and hard exudates[2] [Figure 1]a and [Figure 1]b. Optical coherence tomography (OCT) of the macula (OU) showed multiple hyperreflective intraretinal dot-like foci[3] and accumulation of subretinal fluid at the fovea in OD and intraretinal fluid in OS [Figure 2]a and [Figure 2]b. The laboratory tests for complete blood count, urea, electrolytes, enzymes, and antinuclear antibodies (ANA) were within normal range. Test results were negative for HIV 1 and 2, Mantoux test, and Rheumatoid factor. The treponema pallidum hemagglutination assay (TPHA) and venereal disease research laboratory test (VDRL) were reactive. Magnetic resonance imaging of the brain and orbit were unremarkable. All the clinical and serological findings prompted towards a diagnosis of syphilitic papilledema with subretinal fluid and intraretinal precipitates. The patient received treatment for syphilis, and after one month he presented with an improvement in symptoms and resolution of disc edema [Figure 3]a and [Figure 3]b.
Figure 1: (a and b) Color fundus photograph showing papilledema with peripapillary hemorrhages, hard exudates, and cotton wool spots (OU)

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Figure 2: (a and b) OCT macula showing multiple hyperreflective dot-like foci in inner retinal layers along with subretinal fluid at the fovea (OU)

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Figure 3: (a and b) Color fundus photograph showing gradually resolving optic disc edema (OU) at one-month follow-up visit

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  Discussion Top


Syphilis can present with nonspecific ocular signs and symptoms. Hyperreflective pyramidal lesions can be seen in the retinal pigment epithelium and outer retinal layers on OCT in these patients.[4]

Diagnosing a case of ocular syphilis is associated with a combination of symptoms and signs verified by laboratory studies of blood and CSF,[5] ocular symptoms due to papilledema as well as photoreceptor changes, miliary retinal lesions,[6] placoid chorioretinitis,[7] and positive treponemal test and VDRL test in serum. Our findings underline that ocular syphilis is diagnosed through the systematic exclusion of alternative diagnoses, and its clinical presentation can be a clue toward diagnosing ocular syphilis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McNally MA, Murira A, Dillard CM, Aisenberg G. The great masquerader: Syphilis mimicking papilledema and traction alopecia. Cureus 2020;12:e7391.  Back to cited text no. 1
    
2.
Gonzalez-Martinez A, Quintas S, Vivancos DC, Cebrián J, Vivancos J. Diagnosis of syphilitic bilateral papillitis mimicking papilloedema. Emerg Infect Dis 2020;26:171-3.  Back to cited text no. 2
    
3.
Lima LH, de Andrade GC, Vianello S, Zett C, Farah ME, Belfort R, et al. Multimodal imaging analyses of hyperreflective dot-like lesions in acute syphilitic posterior placoid chorioretinopathy. J Ophthalmic Inflamm Infect 2017;7:1.  Back to cited text no. 3
    
4.
Hu KS, Vitale AT, Shakoor A, Larochelle M, Sassalos T, Elner SG, et al. Pyramidal inflammatory deposits of the retinal pigment epithelium and outer retina in ocular syphilis. Ophthalmol Retina 2022;6:172-8.  Back to cited text no. 4
    
5.
Workowski KA, Berman SM. CDC sexually transmitted diseases treatment guidelines. Clin Infect Dis Off Publ Infect Dis Soc Am 2002;35(Suppl 2):S135-7.  Back to cited text no. 5
    
6.
Pathengay A, Kaza H, Tyagi M, Patel A, Pappuru RR, Agrawal H, et al. Miliary retinal lesions in ocular syphilis: Imaging characteristics and outcomes. Ocul Immunol Inflamm 2021;29:102-6.  Back to cited text no. 6
    
7.
Eandi CM, Neri P, Adelman RA, Yannuzzi LA, Cunningham ET Jr; International Syphilis Study Group. Acute syphilitic posterior placoid chorioretinitis: Report of a case series and comprehensive review of the literature. Retina 2012;32:1915-41.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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