Tertiary Syphilis-Induced Ocular Syphilis Complicated by Retinal Detachment

Abstract

Tertiary syphilis can cause eye diseases such as ocular syphilis and retinal detachment. Herein, we present a case of a 28-year-old male with no reported past medical history. He presented to the emergency department with complaints of pain, blurriness, and vision loss in his left eye, leading to a fall during a recent ophthalmologist visit. Diagnosis typically relies on detailed clinical examination, lumbar punctures, and serological testing to diagnose and manage the patient's condition. The results of these tests led to the diagnosis of tertiary syphilis-induced ocular syphilis complicated by retinal detachment, which was treated with penicillin G intravenously (IV) daily. The patient was transferred to a long-term acute care facility with an ophthalmologist follow-up post-admission. This case highlights the importance of recognizing and emphasizing timely diagnosis of ocular syphilis and proper disease management as a crucial factor in preventing permanent vision loss.

Keywords: ocular syphilis; retinal detachment; syphilis; tertiary syphilis; vision loss.

Figure 1. Fluorescein angiographic imaging of the patient's right eye

Fluorescein angiographic imaging of the patient's right eye was used to reveal diffuse hyperfluorescence of the retinal vasculature denoted by the blue arrows, indicative of vasculature inflammation due to an infectious etiology. The red arrow denotes the significance of the optic disc appearing unaffected, with no evidence of leakage or hyperfluorescence at the level of the disc.

Figure 2. Fluorescein angiographic imaging of the left eye (affected eye)

Fluorescein angiographic imaging of the left eye (affected eye) was used as the diagnostic study of choice to characterize the symptomatic findings. (A) The red arrow indicates hyperfluorescence due to retinal vascular leakage, which is characteristic of active inflammation in panuveitis. (B) The red arrow highlights areas of optic disc hyperfluorescence, indicating optic disc leakage secondary to inflammation. This finding reflects possible optic neuritis or perineural involvement. (C) The red arrow points to a localized area of hyperfluorescence in the mid-retina. (D) The red arrow mark diffuse staining and leakage. (A–D) The blue arrows exemplified in each of these images denoting diffuse hyperfluorescence of the retinal vasculature, indicative of vasculature inflammation.