Syphilitic uveitis in human immunodeficiency virus-infected patients
I. A. Shalaby, J. P. Dunn, R. D. Semba and D. A. Jabs
Ocular Immunology Service, Wilmer Ophthalmological Institute, Baltimore, Md, USA.
OBJECTIVE: To document the incidence and clinical features of syphilitic
uveitis in patients coinfected with human immunodeficiency virus (HIV).
DESIGN: Retrospective chart review. SETTINGS: Single tertiary uveitis
referral center. PATIENTS: The charts of HIV-infected patients with uveitis
and a reactive fluorescent treponemal antibody absorption test seen between
November 1983 and June 1995 were reviewed. RESULTS: Syphilis was the most
common bacterial cause of uveitis in this group. Thirteen patients (0.6% of
the 2085 HIV-positive patients seen in the clinic during the study period)
were dually infected. Twelve patients were male. Six patients (46%) had
previously been treated for syphilis, 4 with intramuscular penicillin G
benzathine only. Four patients (31%) had isolated anterior uveitis, 3
patients (23%) had anterior and intermediate uveitis, and 5 patients (38%)
had panuveitis. One patient (8%) presented with optic nerve and retinal
atrophy. Eight patients were treated with intravenous penicillin, 3 with
intravenous and intramuscular penicillin, and 1 with intravenous
ceftriaxone sodium. Of the 12 patients for whom follow-up examinations were
available after treatment, ocular inflammation decreased in 11 (92%) and
visual acuity improved in 8 (67%). Rapid plasma reagin titers decreased a
median of 64-fold compared with pretreatment levels, and all patients with
reactive cerebrospinal fluid who underwent pretreatment and posttreatment
lumbar punctures normalized following therapy with intravenous antibiotics.
CONCLUSIONS: Syphilis is an uncommon cause of uveitis in HIV-infected
patients. Anterior uveitis is the most common ocular manifestation, but
panuveitis is more common than isolated anterior uveitis. Intravenous
penicillin is effective therapy.
