Abstract

Ocular manifestations of syphilis occurs in 0.6% to 2% of patients with any stage of the disease. This is a case report of a 28 year old fashion designer, being treated for palmoplantar psoriasis for 6 months, presented to his local Ophthalmologist with an acute, painless, decrease in vision in the left eye for 1 month. He was diagnosed as optic neuritis and treated with intravenous methylprednisolone for 3 days. Since he developed mild neurological symptoms and had no improvement in vision he presented to us for further evaluation. Within a week of presentation, he went from unilateral atypical optic neuritis to bilateral panuveitis. Baseline investigations revealed serum TPHA reactive in >2560 dilution and RPR – reactive in 64 dilution and CSF TPHA reactive in 640 dilution and RPR – reactive in 4 dilution. He was also HIV positive with a CD4+ T cells absolute count = 199 cells / ul. He was treated with intravenous penicillin, topical and oral steroids and antiretroviral therapy.