Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations
Autor(a) principal: | |
---|---|
Data de Publicação: | 2023 |
Outros Autores: | , , , , , , |
Tipo de documento: | Relatório |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48560/rspo.28783 |
Resumo: | INTRODUCTION: Ocular syphilis has a highly heterogeneous clinical presentation, which can overlap with many other etiologies. Its diagnosis requires a high index of suspicion. Ophthalmological manifestations may appear in virtually all anatomical regions of the eye, in both the anterior and posterior segments. Uveitis is the most common ophthalmologic presentation of syphilis, and the timing of onset is variable and unpredictable. The purpose of this work is to describe 5 consecutive cases of ocular inflammation, with heterogeneous manifestations, eventually diagnosed as ocular syphilis. METHODS: A case-series report of consecutive eyes, including 5 cases of patients diagnosed and treated for ocular syphilis in Hospital Pedro Hispano – Unidade Local de Saúde de Matosinhos, in the year of 2022. Patients were managed in collaboration between the ophthalmologic and infectious diseases departments and were hospitalized for systemic treatment. RESULTS: Case 1 reports a 29-year-old man with bilateral non-granulomatous iridocyclitis. Case 2 refers to bilateral asymmetrical papillitis. Case 3 consists of a unilateral panuveitis with dense vitritis, in a patient with HIV co-infection. Case 4 depicts bilateral asymmetrical neuroretinitis. Case 5 reports granulomatous iridocyclitis in a patient with a hypermature cataract, initially regarded as lens-induced uveitis. CONCLUSION: Syphilitic uveitis may occur at any stage of the systemic disease. A high clinical suspicion is necessary, and it must be considered in all cases of unexplained ocular inflammation. HIV-coinfection is common, and results in more severe disease, with worse prognosis. Poor initial visual acuities appear to be related to bad visual outcomes. Systemic treatment should be started promptly when there is suspicion of the infection. Detailed medical history and systemic physical examination are essential tools to help the diagnosis. |
id |
RCAP_952754eafc89d605f9ad6909402c6780 |
---|---|
oai_identifier_str |
oai:ojs.revistas.rcaap.pt:article/28783 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical PresentationsExpondo a Grande Imitadora: Cinco Casos Consecutivos de Sífilis Ocular com Apresentações Clínicas HeterogéneasCasos ClínicosINTRODUCTION: Ocular syphilis has a highly heterogeneous clinical presentation, which can overlap with many other etiologies. Its diagnosis requires a high index of suspicion. Ophthalmological manifestations may appear in virtually all anatomical regions of the eye, in both the anterior and posterior segments. Uveitis is the most common ophthalmologic presentation of syphilis, and the timing of onset is variable and unpredictable. The purpose of this work is to describe 5 consecutive cases of ocular inflammation, with heterogeneous manifestations, eventually diagnosed as ocular syphilis. METHODS: A case-series report of consecutive eyes, including 5 cases of patients diagnosed and treated for ocular syphilis in Hospital Pedro Hispano – Unidade Local de Saúde de Matosinhos, in the year of 2022. Patients were managed in collaboration between the ophthalmologic and infectious diseases departments and were hospitalized for systemic treatment. RESULTS: Case 1 reports a 29-year-old man with bilateral non-granulomatous iridocyclitis. Case 2 refers to bilateral asymmetrical papillitis. Case 3 consists of a unilateral panuveitis with dense vitritis, in a patient with HIV co-infection. Case 4 depicts bilateral asymmetrical neuroretinitis. Case 5 reports granulomatous iridocyclitis in a patient with a hypermature cataract, initially regarded as lens-induced uveitis. CONCLUSION: Syphilitic uveitis may occur at any stage of the systemic disease. A high clinical suspicion is necessary, and it must be considered in all cases of unexplained ocular inflammation. HIV-coinfection is common, and results in more severe disease, with worse prognosis. Poor initial visual acuities appear to be related to bad visual outcomes. Systemic treatment should be started promptly when there is suspicion of the infection. Detailed medical history and systemic physical examination are essential tools to help the diagnosis.INTRODUÇÃO: A sífilis ocular tem uma apresentação clínica altamente heterogénea, que se pode sobrepor à de muitas outras etiologias. O seu diagnóstico requer um alto índice de suspeição. As manifestações oftalmológicas podem afetar praticamente todas as regiões anatómicas do olho, tanto no segmento anterior como no posterior. A uveíte é a apresentação oftalmológica mais frequente, e o timing do aparecimento é variável e imprevisível. O objectivo deste trabalho foi descrever 5 casos consecutivos de inflamação ocular, com manifestações heterogéneas, eventualmente diagnosticados como sífilis ocular. MÉTODOS: Série de casos consecutivos, incluindo 5 doentes diagnosticados com sífilis ocular e tratados no Hospital Pedro Hispano – Unidade Local de Saúde de Matosinhos, no ano de 2022. A abordagem dos doentes envolveu os Serviços de Oftalmologia e Infecciologia. Todos os doentes foram internados para cumprir o tratamento sistémico. RESULTADOS: O caso 1 relata um homem de 29 anos com iridociclite bilateral não granulomatosa. O caso 2 corresponde a uma papilite bilateral assimétrica. O caso 3 consiste numa panuveíte unilateral com vitrite densa, num doente com co-infeção por VIH. O caso 4 descreve uma neurorretinite bilateral assimétrica. O caso 5 representa uma iridociclite granulomatosa numa doente com uma catarata brunescente, inicialmente diagnosticado como uma lens-induced uveitis. CONCLUSÃO: A uveíte sifilítica pode surgir em qualquer fase da doença sistémica. É necessária uma elevada suspeita clínica, que deve levar a que este diagnóstico seja considerado em casos de inflamação ocular inexplicada. A co-infeção por VIH é comum, e resulta numa doença mais grave e com pior prognóstico. Acuidades visuais inicialmente baixas estão relacionadas com resultados visuais a longo prazo desfavoráveis. O tratamento sistémico deve ser iniciado prontamente quando há suspeita da infecção. Uma anamnese detalhada e um exame físico sistémico são ferramentas essenciais para guiar o diagnóstico.Ajnet2023-12-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/reporthttps://doi.org/10.48560/rspo.28783eng1646-69501646-6950Barbosa, Renato CorreiaRamos Oliveira, SusanaGonçalves, Maria JoãoMota, ÁgataBasto, RitaViana, Ana RitaSilva, AlexandreGonçalves, Ritainfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-01-04T20:30:32Zoai:ojs.revistas.rcaap.pt:article/28783Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T01:30:08.131730Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations Expondo a Grande Imitadora: Cinco Casos Consecutivos de Sífilis Ocular com Apresentações Clínicas Heterogéneas |
title |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations |
spellingShingle |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations Barbosa, Renato Correia Casos Clínicos |
title_short |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations |
title_full |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations |
title_fullStr |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations |
title_full_unstemmed |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations |
title_sort |
Exposing the Great Masquerader: Five Consecutive Cases of Ocular Syphilis with Heterogeneous Clinical Presentations |
author |
Barbosa, Renato Correia |
author_facet |
Barbosa, Renato Correia Ramos Oliveira, Susana Gonçalves, Maria João Mota, Ágata Basto, Rita Viana, Ana Rita Silva, Alexandre Gonçalves, Rita |
author_role |
author |
author2 |
Ramos Oliveira, Susana Gonçalves, Maria João Mota, Ágata Basto, Rita Viana, Ana Rita Silva, Alexandre Gonçalves, Rita |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Barbosa, Renato Correia Ramos Oliveira, Susana Gonçalves, Maria João Mota, Ágata Basto, Rita Viana, Ana Rita Silva, Alexandre Gonçalves, Rita |
dc.subject.por.fl_str_mv |
Casos Clínicos |
topic |
Casos Clínicos |
description |
INTRODUCTION: Ocular syphilis has a highly heterogeneous clinical presentation, which can overlap with many other etiologies. Its diagnosis requires a high index of suspicion. Ophthalmological manifestations may appear in virtually all anatomical regions of the eye, in both the anterior and posterior segments. Uveitis is the most common ophthalmologic presentation of syphilis, and the timing of onset is variable and unpredictable. The purpose of this work is to describe 5 consecutive cases of ocular inflammation, with heterogeneous manifestations, eventually diagnosed as ocular syphilis. METHODS: A case-series report of consecutive eyes, including 5 cases of patients diagnosed and treated for ocular syphilis in Hospital Pedro Hispano – Unidade Local de Saúde de Matosinhos, in the year of 2022. Patients were managed in collaboration between the ophthalmologic and infectious diseases departments and were hospitalized for systemic treatment. RESULTS: Case 1 reports a 29-year-old man with bilateral non-granulomatous iridocyclitis. Case 2 refers to bilateral asymmetrical papillitis. Case 3 consists of a unilateral panuveitis with dense vitritis, in a patient with HIV co-infection. Case 4 depicts bilateral asymmetrical neuroretinitis. Case 5 reports granulomatous iridocyclitis in a patient with a hypermature cataract, initially regarded as lens-induced uveitis. CONCLUSION: Syphilitic uveitis may occur at any stage of the systemic disease. A high clinical suspicion is necessary, and it must be considered in all cases of unexplained ocular inflammation. HIV-coinfection is common, and results in more severe disease, with worse prognosis. Poor initial visual acuities appear to be related to bad visual outcomes. Systemic treatment should be started promptly when there is suspicion of the infection. Detailed medical history and systemic physical examination are essential tools to help the diagnosis. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-12-29 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/report |
format |
report |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.48560/rspo.28783 |
url |
https://doi.org/10.48560/rspo.28783 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1646-6950 1646-6950 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Ajnet |
publisher.none.fl_str_mv |
Ajnet |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799136783497166848 |