obsolete secondary syphilitic chorioretinitis

Obsolete Secondary Syphilitic Chorioretinitis: A Rare Manifestation

Secondary syphilitic chorioretinitis is a rare manifestation of ocular syphilis, characterized by inflammation of the choroid and retina. According to various studies [6][8], this condition can manifest in different stages of syphilis, including secondary and tertiary stages.

Clinical Features

The clinical features of obsolete secondary syphilitic chorioretinitis include:

• Multifocal Choroidal Lesions: Characteristic "birdshot" spots (multifocal cream-colored or yellow-orange, oval or round choroidal lesions) on ophthalmoscopy [9]
• Retinal Vasculitis: Inflammation of the retinal blood vessels
• Chorioretinitis: Inflammation of the choroid and retina

Ocular Manifestations

The ocular manifestations of obsolete secondary syphilitic chorioretinitis can include:

• Anterior Uveitis: Inflammation of the anterior chamber of the eye
• Vitritis: Inflammation of the vitreous body
• Neuroretinitis: Inflammation of the retina and optic nerve

Complications

If left untreated, obsolete secondary syphilitic chorioretinitis can lead to severe vision loss [11]. Therefore, prompt diagnosis and treatment are essential to prevent complications.

References

[6] Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye. It is a form of posterior uveitis. [8] Ocular disease is primarily associated with secondary syphilis. Manifestations include anterior uveitis, vitritis, neuroretinitis, multifocal chorioretinitis ... [9] Characteristic “birdshot” spots (multifocal cream-colored or yellow-orange, oval or round choroidal lesions) on ophthalmoscopy [11] Syphilitic chorioretinitis could produce severe vision loss . However, few reports have systematically listed the clinical manifestations of syphilitic chorioretinitis at different stages.

Signs and Symptoms of Obsolete Secondary Syphilitic Chorioretinitis

Secondary syphilitic chorioretinitis is a rare condition that was once associated with the secondary stage of syphilis. While it's no longer considered a common manifestation of the disease, understanding its historical signs and symptoms can provide valuable insights.

Fever and Skin Rash In the past, patients with secondary syphilitic chorioretinitis often presented with fever, swollen lymph nodes, and skin rash, as well as wart-like genital lesions (condyloma lata) [1][3]. These symptoms were indicative of the systemic nature of the disease.

Choroidal Involvement The condition was characterized by inflammation of the choroid, a thin pigmented vascular coat of the eye. This led to chorioretinitis, an inflammation of the choroid and retina [8].

Visual Symptoms Patients often experienced photopsias (flashing lights), subjective scotomas (blind spots), and decreased visual acuity [10]. These symptoms were indicative of the involvement of the retina and optic nerve.

Other Manifestations In some cases, patients presented with a maculopapular rash on the palms and soles, as well as ocular manifestations such as uveitis [4].

It's essential to note that secondary syphilitic chorioretinitis is no longer considered a common manifestation of syphilis. The disease has evolved, and its presentation has changed over time.

References:

[1] Nov 27, 2020 — In secondary syphilis, fever, swollen lymph nodes and skin rash, and wart-like genital lesions (condyloma lata) can be seen. [3] Apr 1, 2021 — In secondary syphilis, fever, swollen lymph nodes and skin rash, and wart-like genital lesions (condyloma lata) can be seen. [4] Oct 1, 2007 — Patients at this stage most commonly present with fever and a maculopapular rash on the palms and soles. [8] Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye. It is a form of posterior uveitis. [10] by I Papasavvas · 2022 · Cited by 12 — The patients often present the triad of symptoms including photopsias, subjective scotomas and (not always) decreased visual acuity.

Based on the provided context, it appears that there are several diagnostic tests that can be used to diagnose secondary syphilitic chorioretinitis.

• Lab tests: Material swabbed from the eye can be tested for infections using lab tests [12].
• Optical coherence tomography (OCT): This imaging test uses reflected light to take pictures of the back of the eye, which can help identify inflammation in the choroid and retina [12].
• Fluorescein angiography: This test can verify focal chorioretinitis on the posterior pole, as seen in one case study [14].

In addition to these tests, serological testing for syphilis is also crucial in diagnosing secondary syphilitic chorioretinitis. The following tests are mentioned:

• RPR (Rapid Plasma Reagin) test: This nontreponemal card test can be used to diagnose syphilis, with a high or rising titer of organism-specific IgG indicating the presence of the disease [5].
• VDRL (Venereal Disease Research Laboratory) test: This non-treponemal test can also be used to diagnose syphilis, although it may not always produce accurate results in cases of secondary syphilitic chorioretinitis [2].
• Treponemal tests: These tests, such as the EIA (Enzyme Immunoassay) and TPHA (Treponema pallidum Hemagglutination Assay), can be used to confirm a diagnosis of syphilis in cases where the VDRL test is negative [4].

It's worth noting that a combination of these tests may be necessary to accurately diagnose secondary syphilitic chorioretinitis.

Treatment of Secondary Syphilitic Chorioretinitis

The treatment for ocular syphilis, including secondary syphilitic chorioretinitis, is identical to that of neurosyphilis [1]. For patients with primary, secondary, and early stage latent syphilis, the treatment of choice is intramuscular penicillin benzathine G at a dose of 2.4 million units [1].

Specific Treatment for Secondary Syphilitic Chorioretinitis

In cases where secondary syphilitic chorioretinitis has been diagnosed, appropriate treatment with penicillin benzathine G is instituted in each patient [8]. This typically involves a dose of 2.4 million units administered intramuscularly.

Alternative Treatment for Penicillin Allergy

For patients who are allergic to penicillin, desensitization should be considered [4]. In some cases, alternative treatments such as plasmapheresis and intravenous methylprednisolone may also be used in conjunction with penicillin treatment [15].

Importance of Prompt Treatment

Prompt treatment is essential to prevent further vision loss and complications. It is crucial to diagnose and treat secondary syphilitic chorioretinitis promptly, as delays can lead to severe visual impairment.

References:

[1] The treatment for ocular syphilis is identical to that of neurosyphilis. [4] Desensitization should be considered for patients who are allergic to penicillin. [8] Appropriate treatment with penicillin benzathine G is instituted in each patient with secondary syphilitic chorioretinitis. [15] Alternative treatments such as plasmapheresis and intravenous methylprednisolone may also be used in conjunction with penicillin treatment.

Differential Diagnosis of Obsolete Secondary Syphilitic Chorioretinitis

Secondary syphilitic chorioretinitis is a rare manifestation of secondary syphilis, characterized by placoid lesions in the macula. When considering the differential diagnosis for obsolete secondary syphilitic chorioretinitis, several conditions should be taken into account.

• Retinoblastoma: This is an important differential diagnosis to consider, as it can present with similar symptoms, including placoid lesions (1). However, retinoblastoma typically affects children and young adults, whereas secondary syphilitic chorioretinitis primarily affects adults.
• Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): This condition is characterized by sudden onset of placoid lesions in the macula, similar to those seen in secondary syphilitic chorioretinitis. However, APMPPE typically resolves spontaneously within a few weeks, whereas secondary syphilitic chorioretinitis requires treatment (10).
• Panuveitis: This is another condition that should be considered in the differential diagnosis of obsolete secondary syphilitic chorioretinitis, particularly in HIV-positive patients (6). However, panuveitis typically presents with more widespread inflammation and is not limited to the macula.
• Syphilitic Chorioretinitis: This is a rare manifestation of tertiary syphilis that can present with placoid lesions in the macula. However, it is less common than secondary syphilitic chorioretinitis and typically affects older adults (11).

Key Points to Consider

• Age: Secondary syphilitic chorioretinitis primarily affects adults, whereas retinoblastoma typically affects children and young adults.
• Duration of Symptoms: APMPPE typically resolves spontaneously within a few weeks, whereas secondary syphilitic chorioretinitis requires treatment.
• HIV Status: Panuveitis is more common in HIV-positive patients and typically presents with more widespread inflammation.

Conclusion

When considering the differential diagnosis for obsolete secondary syphilitic chorioretinitis, it is essential to take into account the age of the patient, duration of symptoms, and HIV status. Retinoblastoma, APMPPE, panuveitis, and syphilitic chorioretinitis are all potential differential diagnoses that should be considered in the evaluation of this condition.