Ocular syphilis: a case report

Abstract

Introduction: Since the year 2000, the incidence of syphilis has increased, currently representing an important public health problem. Ocular syphilis can occur at any stage of the disease, with manifestations in different parts of the eye. This clinical case highlights the importance of primary healthcare in addressing the disease and subsequent collaboration with other specialties.

Case description: I.B., 63-year-old female patient. Personal history of depression, epilepsy, high blood pressure, deafness, smoking, ischemic heart disease, and a poor economic environment. The patient visited her health center in January 2023 for a consultation due to persistent complaints of redness and discomfort in her left eye, which had not responded to topical agents. She presented with scleral inflammation, with great vascular congestion and diffuse hyperemia. Since the symptoms persisted regardless of the medication and considering her personal history, it was imperative to conduct a deeper and broader investigation for systemic causes. One month later, several circular lesions were identified on the hands and two on the perineum area, concurrent with positivity for syphilis. She was referred to an Ophthalmology and Infectious Diseases consultation and was diagnosed with syphilitic panuveitis. She started treatment with intravenous penicillin for 14 days. Lumbar puncture and brain MRI were performed to detect neurosyphilis, both without alterations. The post-therapeutic RPR indicated a 4-fold reduction in the pre-therapeutic titration value, synonymous with success.

Comment: This case of syphilis, considered by many authors to be the great imitator, demonstrates the importance of the holistic approach of the family doctor. In addition to being the first to observe the initial symptoms of disease, often non-specific, he can integrate with the personal and family background, which, combined with a high degree of suspicion, contributes to the diagnosis.