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      Necrotizing retinitis in a patient with syphilis : A case report

      case-report
      , PhD, , PhD, , PhD
      Medicine
      Lippincott Williams & Wilkins
      case report, necrotizing retinitis, syphilis

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          Abstract

          Rationale:

          Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. Necrotizing retinitis is a rare manifestation of ocular syphilis and mimics ARN.

          Patient concerns:

          We report a male patient who presented with bilateral dense vitritis obscuring fundus details similar to ARN, as a rare reported manifestation of syphilis, who was initially given intravitreal ganciclovir.

          Diagnosis:

          After the results for herpes viral PCR disclosed negative, the diagnosis of syphilitic necrotizing retinitis was made based on positive RPR.

          Intervention and Outcomes:

          With the clinical diagnosis of ocular syphilis, treatment with intravenous penicillin was promptly initiated. His visual acuity improved to 20/100 in the right eye and still light perception in the left. Pars plana vitrectomy with silicon oil tamponade was performed in his left eye.

          Lessons:

          Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. However, whenever ARN is clinically suspected, empiric treatment against herpetic viruses should be promptly administered while awaiting further infectious disease study results. Recognition of syphilitic retinitis and prompt initiation of intravenous penicillin is of critical important for clinicians.

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          Most cited references6

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          Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology.

          To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN).
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            • Abstract: not found
            • Article: not found

            Syphilitic uveitis.

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              • Article: not found

              Syphilitic retinitis. A cause of necrotizing retinitis.

              A healthy-appearing male patient presented with signs of unilateral fibrinous iritis, necrotizing retinitis, retinal vasculitis, and vitritis, suggestive of a herpesvirus retinitis or acute retinal necrosis syndrome (ARN). The patient, an active homosexual, withheld the details of his sexual history, portraying himself as exclusively heterosexual. With the exception of a positive VDRL and FTA-ABS, the workup was negative. Examination of the cerebrospinal fluid confirmed the presence of neurosyphilis. The patient was successfully treated with intravenous penicillin, which resulted in a complete visual recovery. Syphilitic retinitis must be considered in evaluating patients with necrotizing retinitis.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                05 March 2021
                05 March 2021
                : 100
                : 9
                : e24452
                Affiliations
                Eye Center of the Second Hospital, Jilin University, Changchun City, Jilin Province, China.
                Author notes
                []Correspondence: Guanfang Su, Eye Center of the Second Hospital, Jilin University, 4026 Yatai Street, Changchun 130021, Jilin, China ( e-mails: sugf2012@ 123456163.com ).
                Article
                MD-D-20-01329 24452
                10.1097/MD.0000000000024452
                7939152
                33655916
                134b2361-6bf0-47b0-ad25-9fe6e552ca0d
                Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 18 February 2020
                : 25 December 2020
                : 6 January 2021
                Categories
                5800
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                case report,necrotizing retinitis,syphilis
                case report, necrotizing retinitis, syphilis

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