Advertisement

The Mydriatic Red Eye as the Initial Presentation of Syphilis

      Abstract

      Background

      Syphilis is a sexually transmitted infection that has been increasing in prevalence since the early 2000s. Ocular involvement occurs in a minority of patients and must be in the differential diagnosis for patients who present with red eye and uveitis.

      Case Report

      A 29-year-old woman presented to the emergency department with a painful, mydriatic red eye. Review of systems revealed a rash as well as a recent genital lesion and, on further questioning, she admitted to a history of intravenous drug use and high-risk sexual activity. Ophthalmology was consulted and the patient was diagnosed with bilateral uveitis. Serologic testing was positive for syphilis, and she was admitted and treated with intravenous penicillin, with resolution of her uveitis.

      Why Should an Emergency Physician Be Aware of This?

      Red eye is a common ocular symptom in patients presenting to the emergency department. The differential diagnosis of the red eye is broad and can range from benign etiologies, such as conjunctivitis, to life- and sight-threatening conditions, such as endogenous endophthalmitis. Systemic diseases such as syphilis may present with primarily ocular symptoms, and ocular syphilis must be identified and managed appropriately to prevent devastating sequelae.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cronau H
        • Kankanala RR
        • Mauger T.
        Diagnosis and management of red eye in primary care.
        Am Fam Physician. 2010; 81: 137-144
      1. Frings A, Geerling G, Schargus M. Red eye: a guide for non-specialists [published correction appears in Dtsch Arztebl Int. 2017 Sep 22;114(38):641] [published correction appears in Dtsch Arztebl Int. 2017 Jul;114(24):418]. Dtsch Arztebl Int 2017;114:302–2.

      2. Figures – Sexually Transmitted Disease Surveillance, 2019. Centers for Disease Control and Prevention. Published April 13, 2021. Accessed October 17, 2021. https://www.cdc.gov/std/statistics/2019/figures.htm

        • Kojima N
        • Klausner JD.
        An update on the global epidemiology of syphilis.
        Curr Epidemiol Rep. 2018; 5: 24-38
        • Peeling RW
        • Mabey D
        • Kamb ML
        • Chen XS
        • Radolf JD
        • Benzaken AS
        Syphilis.
        Nat Rev Dis Primers. 2017; 3: 17073
        • Singh AE
        • Romanowski B.
        Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features.
        Clin Microbiol Rev. 1999; 12: 187-209
        • Sexually Transmitted Infections Treatment Guidelines
        Syphilis.
        Centers for Disease Control and Prevention. 2021; (Accessed March 24, 2022)
        • Jahnke S
        • Sunderkötter C
        • Lange D
        • Wienrich R
        • Kreft B.
        Ocular syphilis – a case series of four patients.
        J Dtsch Dermatol Ges. 2021; 19: 987-991
        • Amaratunge B
        • Camuglia J
        • Hall A.
        Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients.
        Clin Exp Ophthalmol. 2010; 38: 68-74
        • Barile GR
        • Flynn TE.
        Syphilis exposure in patients with uveitis.
        Ophthalmology. 1997; 104: 1605-1609
      3. Sexually Transmitted Infections Treatment Guidelines. Neurosyphilis, Ocular Syphilis, and Otosyphilis. Centers for Disease Control and Prevention. Published July 22, 2021. Accessed October 17, 2021. https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm

        • Lee MI
        • Lee AW
        • Sumsion SM
        • Gorchynski JA.
        Don't forget what you can't see: a case of ocular syphilis.
        West J Emerg Med. 2016; 17: 473-476
        • Patton ME
        • Su JR
        • Nelson R
        • Weinstock H
        Centers for Disease Control and Prevention (CDC). Primary and secondary syphilis—United States, 2005-2013.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 402-406
        • Rose-Nussbaumer J
        • Goldstein DA
        • Thorne JE
        • et al.
        Uveitis in human immunodeficiency virus-infected persons with CD4+ T-lymphocyte count over 200 cells/mL.
        Clin Exp Ophthalmol. 2014; 42: 118-125
        • Cunningham Jr., ET
        Uveitis in HIV positive patients.
        Br J Ophthalmol. 2000; 84: 233-235
      4. Katz DA, Berger JR, Duncan RC. Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus [published correction appears in Arch Neurol 1993 Jun;50(6):614]. Arch Neurol 1993;50:243–9.

        • Lee SY
        • Cheng V
        • Rodger D
        • Rao N.
        Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection.
        J Ophthalmic Inflamm Infect. 2015; 5: 56
        • Kunkel J
        • Schürmann D
        • Pleyer U
        • et al.
        Ocular syphilis—indicator of previously unknown HIV-infection.
        J Infect. 2009; 58: 32-36