Ocular syphilis mimicking Vogt-Koyanagi-Harada disease - a case report
Purpose
To report a case of bilateral ocular syphilis with the presentation mimicking VKH disease
Methods
A retrospective case report
Results
A 59 y/o female with sicca syndrome and rheumatoid arthritis complained blurred vision of right eye for 5 days. She has been diagnosed with retinal vascular occlusion in left eye 2 months ago. Her BCVA were 0.03 OD and 0.2 OS. IOP was 15mmHg OD and 17mmHg OS. There was no KPs, neither flares nor inflammatory in the anterior chambers. Bilateral disc hyperemia and serous retinal detachment at posterior pole in her both eyes were noticed by fundus exam. FA revealed bilateral late dye leakage from disc and posterior choroid. Color sensation loss in both eyes were also noticed. OCT showed bilateral subretinal fluid, with OD more copious than OS. The patient denied ocular pain, headache, hearing impairment, or other neurological sign. Under the tentative diagnosis of VKH disease, she was admitted for intravenous methylprednisolone pulse therapy. However, positive RPR (1:256) and TPHA (1:2560) were reported during admission. Her diagnosis was revised as bilateral ocular syphilis with optic neuritis and serous retinal detachment.
Conclusion
The differential diagnosis of serous retinal detachment can be divided into vascular, inflammatory, neoplastic and congenital etiologies. In inflammatory etiologies, VKH is common in pigmented races, the incidence rate of Asian population is around 7% to 9%. However, syphilis is one of the greatest masqueraders in clinic. Therefore, it should be considered in differential diagnosis of any intraocular inflammatory disease even it is less than 2% of all uveitis cases.
Conflict of interest
No
Author 1
Last name
LO
Initials of first name(s)
K.J.
Department
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan
Author 2
Last name
HUANG
Initials of first name(s)
D.K.
Department
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan
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