Syphilitic interstitial keratitis: treatment with immunosuppressive drug combination therapy.
OBJECTIVE
The following is a case presentation of congenital syphilitic keratitis in a boy 6 years of age who was successfully treated with an immunosuppressive drug combination therapy.


METHODS
Congenital syphilitic keratitis was diagnosed by clinical findings and laboratory tests. The child was unresponsive to traditional treatment; thus, systemic immunosuppressive therapy, which consisted of oral cyclosporine 4 mg/kg/d, 6 days per week, and oral low-dose steroids (fluocortolone 0.8 mg/kg a week, given every other day), was initiated.


RESULTS
Corneal disease showed great improvement with this therapy, with progressive healing of lesions in the first month of treatment and no signs of toxic renal, hepatic, or growth abnormalities. Recurrences of uveitis have not occurred, and corneal interstitial keratitis episodes have been limited to 3 in an 8-year period. After 6 months with no recurrences, a tapering off of the systemic therapy was initiated, and the child is still asymptomatic and without flare-ups.


CONCLUSIONS
Congenital syphilitic keratitis is usually treated with topical steroids and cycloplegic drugs, which not only can be ineffective but can also lead to complications such as cataract and glaucoma. In the present case report, a pediatric patient affected by syphilitic interstitial keratitis was treated successfully with an immunosuppressive drug combination therapy.
Orsoni
Jelka G
JG
Institute of Ophthalmology, University of Parma, Parma, Italy. jorsoni@unipr.it
Zavota
Laura
L
Manzotti
Francesca
F
Gonzales
Stefania
S
D002648:Child; D003319:Corneal Stroma / Q000187:drug effects / Q000382:microbiology; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005448:Fluocortolone / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D013588:Syphilis Serodiagnosis; D013590:Syphilis, Congenital / Q000188:drug therapy* / Q000382:microbiology
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D005448:Fluocortolone; D016572:Cyclosporine