Patients with ocular syphilis misdiagnosed with macular disease

South Korean and US clinicians have described two separate cases where patients were initially diagnosed with macular disease before being found to have ocular syphilis.

Writing in BMC Infectious Diseases, clinicians from Pusan National University and Stanford University shared that laboratory evaluations for syphilis should be considered – not only for uveitis but also for refractory retinal diseases.

“The current two cases demonstrated that ocular syphilis can masquerade as refractory chronic retinal diseases such as diabetic macular oedema (DMO) and neovascular age-related macular degeneration (AMD),” they highlighted.

The first case involved a 72-year-old man who had been losing vision in his left eye for the past three months.

Following examination of fundus photos and optical coherence tomography (OCT) scans, a diagnosis of wet AMD was made.

After monthly intravitreal injections resulted in little improvement in the patient’s condition, further investigations were conducted and the patient had a positive venereal disease research laboratory test.

Following intravenous infusions of penicillin, the macular exudation improved.

In another case, a 67-year-old woman was initially diagnosed with DME in both eyes.

The patient’s response to intravitreal injections was limited. Routine laboratory evaluations before a vitrectomy revealed a venereal disease research laboratory result.

Levels of subretinal fluid dramatically decreased one week after starting an infusion of penicillin, and resolved three months later.