Case Reports

A particular Irvine Gass syndrome

Case Report Details

First Author: F.March De Ribot SPAIN

Co Author(s):    A. March de Ribot   Á. Giménez   J. Tarrús   S. Ayats   T. Torrent   F. Escalada     

Abstract Details

Purpose:

Ocular syphilis is a neurosyphilis that can mimic a variety of ocular diseases, most commonly uveitis, but also interstitial keratitis, chorioretinitis,retinitis, retinal vasculitis and optic, and cranial neuropathies.

Setting:

Ophthalmology Deparment, University Hospital

Report of Case:

Clinical case report and review of the bibliography An 87-year-old male arrived in the emergency department complaining about the loss of visual acuity of the righteye after complicated cataract surgery 3 months before. The geriatric patient accused of secondary depression and loss of orientation. Theleft eye was amblyope. The visual acuity was RE HM, LE CF. Theanterior segment presented RE iris atrophy and pseudophakia, LEcataract. The retina presented general senile atrophy with pigmentarychanges in the macula of both eyes. The previous studies revealedmacular edema of RE after the surgery that was not present at themoment of the exploration. The patient was orientated as Irvine Gasssyndrome and was in treatment with topical corticoids, and AINES. Results: The diagnostic approach was Acute syphilitic posterior placoid chorioretinitis. The OCT presented typicalhyperreflective alterations to the photoreceptor layer. The patienthad psoriasis-like lesions in hands, palms, and plants. Theserologies revealed VDRL, FTA +, and HIV-, neutrophils were presentin cerebrospinal fluid. After that, the patient confessed recentsexual relations with a prostitute. Treatment with penicillin 4mUI 4hfor 14 days. Evolution improved VA and the general condition of thepatient.

Conclusion/Take Home Message:

Syphilis is a multisystem,chronic bacterial infection that can affect multiple organ systems, including skin, heart, blood vessels, bones, nervous system, and eye leading to various clinical manifestations. Transmission occurs most often during sexual contact, especially in men who have sex with men and people infected with HIV. Syphilis is one of the great masqueraders and has to be considered even in improbable presentations.  

Financial Disclosure:

None