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Case Reports
. 2020 Spring;14(2):166-169.
doi: 10.1097/ICB.0000000000000676.

VITREOUS TREPONEMAL ANTIBODY AS A SUPPLEMENTARY TEST TO SEROLOGY FOR THE CONFIRMATION OF SYPHILITIC CHORIORETINITIS

Sukhum Silpa-Archa  1 , Janine M Preble  2 , C Stephen Foster  3   4   5
Affiliations
Case Reports

VITREOUS TREPONEMAL ANTIBODY AS A SUPPLEMENTARY TEST TO SEROLOGY FOR THE CONFIRMATION OF SYPHILITIC CHORIORETINITIS

Sukhum Silpa-Archa et al. Retin Cases Brief Rep. 2020 Spring.

Abstract

Purpose: To report the novel application of nontreponemal and treponemal antibody to confirm diagnosis of ocular syphilis from vitreous samples.

Methods: Two distinct case reports emphasizing the importance of confirmatory vitreous treponemal antibody. Multimodal imaging of patients was also applied.

Results: We report two distinct cases with positive serum treponemal antibody but opposing vitreous treponemal antibody results. One case with a positive vitreous test responded well to antisyphilitic treatment. By contrast, a case with a negative vitreous result was changed to serpiginous choroiditis, eventually cured by immunomodulatory treatment.

Conclusion: Intraocular fluid analysis of nontreponemal and treponemal antibody may play an important role in ruling out suspected ocular syphilis in settings without a polymerase chain reaction facility, especially immunocompromised patients who are at risk of multiple infections. Further studies are needed to establish the sensitivity and specificity of nontreponemal and treponemal antibody test on vitreous samples.

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References

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    1. Rajan MS, Pantelidis P, Tong CY, et al. Diagnosis of Treponema pallidum in vitreous samples using real time polymerase chain reaction. Br J Ophthalmol 2006;90:647–648.
    1. Troutbeck R, Chhabra R, Jones NP. Polymerase chain reaction testing of vitreous in atypical ocular syphilis. Ocul Immunol Inflamm 2013;21:227–230.
    1. Booth J, Rodger A, Singh J, et al. Syphilitic panuveitis with retinal necrosis in an HIV positive man confirmed by Treponema pallidum PCR. J Infect 2009;59:373–375.
    1. Ratnam S. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol 2005;16:45–51.

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