Title
OCULAR SYPHILIS MIMETIZING WET AMD
Summary
An 86 year-old Caucasian woman diagnosed by another ophthalmologist with exudative Age Related Macular Degeneration was referenced to our Institution in order to receive anti-VEGF intravitreous injections. She referred progressive blurred vision for four years in both eyes, denied previous treatment and has already received bilateral phacoemulsification ten years ago. She was under treatment for arrhythmia and used to smoke 5 cigars a day. The patient reported no family history for ocular disease. Her BVAC was 0,7 logMAR OR and finger counting OS, no pathologic changes were seen in anterior segment slit lamp examination. Fundus examination by indirect ophthalmoscopy in the right eye revealed clear vitreous, blurred borders at the optic disc, intense exudation from superior temporal and nasal arcades to posterior pole and nasally to the disc associated with retinal edema and scattered hemorrhages. In the left eye, we could observe the same changes, but there was fibrosis between the fovea and optic disc and greater hemorrhages at the end of the temporal arcade. We found the ocular findings very atypical for exudative AMD, so we decided to complete the investigation. Fluorescein angiogram showed nothing more than the huge exudation and optical coherence tomography found big amount of subretinal fluid and retinal and subretinal exudates in the right eye and foveal fibrosis with retinal cists in the left eye. The results of laboratory workup for infectious and rheumatologic diseases were positive for the treponemal test (FTA-ABS) and suggested ocular syphilis. The patient confirmed that she had unprotected sexual relations. Treatment was determined by neurosyphilis treatment protocol with antibiotics and, then, the patient received oral corticosteroid and subtenon triamcinolone injection. There was an improvement in BVAC, retinal findings and OCT.
Area
CLINICAL CASE
Authors
AMANDA SCHNORR, LEANDRO JEREZ CHAVES, TOMAS OLIVEIRA CASTRO TEIXEIRA PINTO, RODRIGO JORGE