Introduction. There is a trend of increasing frequency of primary and secondary syphilis in developed countries, especially in young men. Ocular manifestations of syphilis are rare but the increasing incidence of syphilitic uveitis requires a multidisciplinary approach. The aim of the study was to describe the epidemiological, clinical and laboratory characteristics of syphilitic uveitis and to document Human Immunodeficiency Virus (HIV) co-infection in a University Hospital-Pleven,
Case report. A twenty-seven year old homosexual man went to see the doctor with a three-month history of decreased vision and floaters in left eye, accompanied by headache on the left. The last two weeks prior to his visit his right eye also was affected. The epidemiological history of the patient showed that he had genital ulcer one year ago, fever, sore throat, fatigue, enlarged cervical lymph nodes initially and later submandibular, axillary, inguinal ones. After a lymph node biopsy and an immunological assay, the lymphomas and infectious mononucleosis were excluded. Decreased CD4 lymphocyte cells (T-helper cells) and increased T-suppressor cells were found. Clinical data and laboratory examinations confirmed syphilis and a HIV co-infection was found. A course of penicillin G was given to the patient, which led to a significant clinical and visual improvement. The outcome was good.
Conclusion. Epidemiological data indicate a worldwide re-emergence of syphilis. Syphilitic uveitis can potentially cause severe loss of vision but is effectively treated by penicillin. All syphilitic uveitis cases should have a HIV screening. The early detection and treatment are important for a good outcome.
Keywords: syphilitic uveitis, HIV co-infection, penicillin.
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Assoc. Prof. Milena Karcheva, MD, PhD
Medical University – Pleven, 1, Sv. Kl. Ohridski Str., Pleven, Bulgaria, 5800
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