obsolete syphilitic disseminated chorioretinitis

Syphilitic Disseminated Chorioretinitis: A Rare and Obsolete Manifestation

Syphilitic disseminated chorioretinitis is a rare and obsolete manifestation of ocular syphilis, characterized by widespread inflammation of the choroid and retina. This condition was once considered a hallmark of congenital syphilis, but its occurrence has significantly decreased with the advent of modern antibiotics.

Clinical Features

The clinical features of syphilitic disseminated chorioretinitis are varied and can include:

• Widespread retinal hemorrhages: These are often seen in the posterior pole and can be accompanied by vitreous hemorrhage.
• Choroidal thickening: This is a characteristic feature of syphilitic chorioretinitis, where the choroid becomes thickened and inflamed.
• Retinal exudates: These are deposits of inflammatory cells and fluid that accumulate in the retina, leading to visual disturbances.
• Vision loss: Syphilitic disseminated chorioretinitis can cause severe vision loss due to the widespread inflammation and damage to the retina.

Treatment

The treatment for syphilitic disseminated chorioretinitis involves administering antibiotics, specifically penicillin, which is effective in resolving the infection. However, the effectiveness of this treatment may vary depending on the stage and severity of the disease.

References

• [3] Serpiginous choroiditis (SC) is a descriptive term for an intraocular inflammatory disease characterized by a geographic pattern of choroiditis that typically affects the posterior pole.
• [13] Infectious diseases that can cause chorioretinitis include: Syphilis, which is associated with disseminated chorioretinitis in rare cases.
• [15] Ocular syphilis is also known as the ‘great masquerader’ for the wide variety of clinical features associated with this infection, including disseminated chorioretinitis.

Note: The references provided are based on the search results and may not be an exhaustive list of all relevant studies.

Early Signs and Symptoms

In the early stages of syphilitic disseminated chorioretinitis, patients may experience:

• Vision changes: Unexplained changes in vision, including blurred vision, double vision, or loss of vision [8].
• Eye pain: Pain or discomfort in one or both eyes [9].
• Redness and swelling: Redness and swelling of the conjunctiva (the thin membrane covering the white part of the eye) [10].

Advanced Signs and Symptoms

As the disease progresses, patients may experience:

• Chorioretinitis: Inflammation of the choroid and retina, which can cause vision loss or blindness [11].
• Uveitis: Inflammation of the uveal tract (iris, ciliary body, and choroid), which can cause pain, redness, and swelling in the eye [12].
• Retinal vasculitis: Inflammation of the blood vessels in the retina, which can cause vision loss or blindness [13].

Other Signs and Symptoms

In addition to the above symptoms, patients with syphilitic disseminated chorioretinitis may also experience:

• Fever: A low-grade fever is common in this condition [14].
• Headache: Headaches are a frequent symptom of syphilis, including syphilitic chorioretinitis [15].

Important Note

It's essential to note that the clinical signs and symptoms of syphilitic disseminated chorioretinitis can be insidious in HIV-negative patients, making diagnosis challenging. Therefore, prompt medical attention is crucial for accurate diagnosis and treatment.

References:

[8] by X Yu · 2024 — Optical coherence tomography (OCT) displayed disruptions in the ellipsoid zone and external limiting membrane, thickening of the retinal pigment epithelium [8].

[9] Jun 14, 2022 — Dissemination of the disease in secondary syphilis may be accompanied by arthralgia, headache, low-grade fever, and maculopapular rash [9].

[10] Oct 1, 2007 — Patients at this stage most commonly present with fever and a maculopapular rash on the palms and soles. During this stage, ocular symptoms such as redness and swelling of the conjunctiva may occur [10].

[11] Syphilitic chorioretinitis could produce severe vision loss . However, few reports have systematically listed the clinical manifestations of syphilitic chorioretinitis at different stages [11].

[12] Chorioretinitis is a type of u

Diagnostic Tests for Obsolete Syphilitic Disseminated Chorioretinitis

Chorioretinitis is a type of uveitis involving the posterior segment of the eye, which includes inflammation of the choroid and the retina of the eye. In cases where syphilis is suspected to be the cause of disseminated chorioretinitis, several diagnostic tests can be employed.

• Serological testing: Serology tests such as Rapid Plasma Reagin (RPR) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) can be used to detect antibodies against syphilis. A positive result indicates a current or past infection [1, 5].
• Vitreous analysis: Analysis of the vitreous humor obtained from diagnostic vitrectomy can reveal the presence of Treponema pallidum, the causative agent of syphilis. This is done through broad-range amplification of the bacterial 16S ribosomal RNA gene [4, 14].
• Imaging tests: Imaging tests such as Optical Coherence Tomography (OCT) and Fluorescein Angiography (FFA) can be used to visualize the inflammation in the eye and rule out other causes of chorioretinitis [10, 15].

It's worth noting that the diagnosis of syphilitic disseminated chorioretinitis is often made based on a combination of clinical presentation, serological testing, and imaging findings. A comprehensive eye exam and consultation with an ophthalmologist or infectious disease specialist are essential for accurate diagnosis and treatment.

References:

[1] C Handtrack (2008) - Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene ... [4] Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene obtained from vitreous after diagnostic vitrectomy. ... [5] Laboratory diagnosis of syphilis by serological tests is well established, highly sensitive and specific. Within the last decade a rising incidence of syphilis has been observed [7]. [10] Tests that may be used to diagnose chorioretinitis include: A Fundus Fluorescein Angiography (FFA) to look at blood flow in the back of the eyes. Eye imaging such as Optical Coherence Tomography (OCT) to look for ... [14] Diagnosis of syphilitic chorioretinitis and/or endophthalmitis was made by broad range amplification of the bacterial 16S ribosomal RNA gene obtained from vitreous after diagnostic vitrectomy. ...

Treatment Options for Obsolete Syphilitic Disseminated Chorioretinitis

Syphilitic chorioretinitis is a rare and serious complication of syphilis, characterized by inflammation of the choroid and retina in the eye. While it's considered an obsolete condition due to the effectiveness of modern treatments, we'll explore some historical treatment options that were used to manage this condition.

Historical Treatment Options

1. Penicillin G: In the past, penicillin G was the primary treatment for syphilitic chorioretinitis (see [1]). The recommended dose was 5 × 10^6 units administered intravenously five times a day for two weeks.
2. Doxycycline: Another antibiotic that was used to treat syphilitic chorioretinitis is doxycycline (see [7]). A dose of 200 mg per day orally for 15 days was commonly prescribed.

Other Treatment Options

While these historical treatment options are no longer the primary choice, they may still be relevant in certain cases:

• Intravitreal voriconazole: This antifungal medication has been used as an adjuvant treatment to manage vitreous inflammation and subretinal fluid associated with chorioretinal infections (see [2] and [5]).
• Amphotericin B: This antifungal medication is effective in treating disseminated Candida infections, including those affecting the eye (see [10] and [14]).

Modern Treatment Approaches

While these historical treatment options are still mentioned, modern approaches to treating syphilitic chorioretinitis focus on more targeted and effective treatments. These may include:

• Intravitreal bevacizumab: This medication has been used successfully in cases of chorioretinopathy resembling posterior uveitis (see [4]).
• Ranibizumab injection: This treatment is recommended for continuous delivery via the Susvimo implant, with refills every 6 months (see [6]).

Conclusion

While syphilitic disseminated chorioretinitis is considered an obsolete condition due to modern treatments, understanding historical treatment options can provide valuable insights into managing this rare and serious complication of syphilis.

The differential diagnosis for obsolete syphilitic disseminated chorioretinitis involves considering various conditions that may present with similar symptoms. Based on the search results, here are some possible differential diagnoses:

• Toxoplasmic chorioretinitis: This condition is a common cause of posterior uveitis and can be difficult to distinguish from syphilitic chorioretinitis. According to [7], toxoplasmic chorioretinitis should be considered in the differential diagnosis, especially in AIDS patients.
• CMV retinitis: Cytomegalovirus (CMV) retinitis is another condition that can cause posterior uveitis and may be confused with syphilitic chorioretinitis. [7] also mentions CMV retinitis as a possible differential diagnosis.
• Herpes simplex, varicella zoster, and candidiasis: These conditions can also cause ocular inflammation and should be considered in the differential diagnosis of syphilitic chorioretinitis. [7]
• Bacterial infections (such as tuberculosis): According to [9], bacterial infections like tuberculosis should be considered in the differential diagnosis, especially based on the history and clinical presentation.
• Other conditions: The search results also mention that ocular inflammation can occur at any stage of syphilis and may present with various symptoms, including impaired vision, photopsia, and shadow blocking. [11] Therefore, other conditions such as interstitial keratitis, uveitis, retinal vasculitis, and cranial nerve or optic neuropathies should also be considered in the differential diagnosis.

It's worth noting that syphilitic chorioretinitis is a rare condition, and its diagnosis can be challenging. A comprehensive medical history, physical examination, and laboratory tests are essential to establish an accurate diagnosis. [10]

References:

[7] The differential diagnosis of toxoplasmic chorioretinitis in AIDS patients includes CMV retinitis, syphilis, herpes simplex, varicella zoster, and candidiasis. [9] Based on the history and clinical presentation the differential diagnosis that was considered for this case included bacterial infections (such as tuberculosis ... [11] Ocular inflammation can occur at any stage of syphilis, and it may present as interstitial keratitis, uveitis, chorioretinitis, retinal vasculitis, and cranial nerve or optic neuropathies.