title: Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection.
abstract: OBJECTIVE
  To describe dense vitritis as the primary manifestation of ocular syphilis in three human immunodeficiency virus (HIV)-positive patients and to determine the response of these patients to the established regimen for neurosyphilis.
  
  
  METHODS
  Anti-Toxoplasma gondii IgM and IgG antibody titers, tuberculin skin test, chest radiograph, and serum angiotensin-converting enzyme level were obtained because tuberculosis, sarcoidosis, and toxoplasmosis were in the differential diagnosis. Two of the three patients were not known to have HIV infection at the time of initial examination and consented to HIV testing. Treponemal and nontreponemal tests were performed on serum and cerebrospinal fluid to establish a definitive diagnosis. Treatment for neurosyphilis was initiated, and daily ophthalmic examinations were performed, with careful attention to signs commonly associated with syphilitic eye disease.
  
  
  RESULTS
  All three patients exhibited improvement in visual acuity and resolution of vitreous haze. There was no evidence of other signs of posterior uveitis. The one patient for whom there has been a 6-month follow-up showed no sequelae of his eye disease.
  
  
  CONCLUSIONS
  Human immunodeficiency virus-positive patients with syphilis may present atypically dense vitritis. In these patients, vitritis may be the first manifestation of syphilis. The regimen for neurosyphilis provides effective therapy. Moreover, in some patients, syphilitic vitritis may be the initial manifestation of HIV disease.
authors.affiliation: Doheny Eye Institute and Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles 90033, USA.
authors.forename: I C
authors.initials: IC
authors.lastname: Kuo
authors.forename: M A
authors.initials: MA
authors.lastname: Kapusta
authors.forename: N A
authors.initials: NA
authors.lastname: Rao
mesh_terms: D000328:Adult; D005128:Eye Diseases / Q000188:drug therapy / Q000209:etiology; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000188:drug therapy; D005654:Fundus Oculi; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010400:Penicillin G / Q000627:therapeutic use; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D013587:Syphilis / Q000150:complications* / Q000188:drug therapy; D013588:Syphilis Serodiagnosis; D015866:Uveitis, Posterior / Q000188:drug therapy / Q000209:etiology*; D014792:Visual Acuity; D014822:Vitreous Body / Q000187:drug effects / Q000473:pathology*
chemical_list: D010406:Penicillins; D010400:Penicillin G; D010401:Penicillin G Benzathine