Title : Hitting the trifecta-ocular syphilis
Abstract:
26 year old male presented to the outpatient department of our clinic with complaints of blurred vision in right eye for past 1 week. It was insidious in onset, and gradual without any associated redness or pain . There was no history of any ocular or head trauma. He did not have a recent history of fever or any systemic infection. There was no prior history of contact with tuberculosis patients. There was no exposure to pets or history of travel outside the country. He did not give any history of high risk behaviour or any long term medication. On examination, left eye was within normal limits. Right eye had a vision of 2/60 with normal intraocular pressure. Anterior segment was within normal limits. There was 1+AVF cells and a large yellowish white retinitis patch temporal to fovea, near the posterior pole , with a few dot like retinitis patches adjacent, along the inferior arcade. A differential diagnosis of retinitis secondary to viral infection was considered and he was empirically started on oral antivirals as we awaited laboratory results. His testing revealed positive VDRL, TPHA as well as HIV. Complete blood count including ESR and CRP were normal and Mantoux was negative. He was sent to the physician, where he was started on antiretroviral therapy as well as intramuscular benzathine penicillin. He reviewed with us 2 weeks later afte,r the second dose of penicillin injection. The retinitis patch had completely resolved, but the vision had improved only marginally as the outer retinal layer of retina was damaged. He was advised to complete the course of penicillin and stay on antiretroviral treatment.
