Case report
The patient reported to the Ophthalmology Emergency Room due to reduced visual acuity for approximately two weeks. He had no previous history of ocular disease. On admission, visual acuity was 0.4 in the right eye and 0.1 in the left eye on Snellen charts. Intraocular pressure in both eyes was normal. Slit-lamp examination showed signs of panuveitis in both eyes and disc oedema in the left eye. The optical coherence tomography (OCT) scan showed inflammatory cells in the vitreous body with photoreceptor layer disruption and abnormalities of the retinal pigment epithelium. (Figure 1) Fluorescein angiography showed inflammation of small peripheral retinal vessels in both eyes. During the hospitalization, lab and imaging tests were performed, confirming the infection with T.pallidum . Blood tests were positive for syphilis EIA with RPR (rapid plasma reagin) of 1:512 titre, FTA-ABS 1:3200 titre, TPHA 1:20480 titre, negative for Toxoplasma, Borrelia, and HIV. Cerebrospinal fluid was positive for syphilis with TPHA titre of 1:80. Head MRI performed was normal. He was administered 5 million units (MU) intravenously of procaine penicillin 4 times a day for 10 days and three intramuscular doses of benzathine penicillin 2.4 MU each at one-week intervals. He was also commenced on oral methylprednisolone and topical steroids: dexamethasone and sub-Tenon’s injection of triamcinolone in the left eye due to macular oedema.