Syphilitic punctate inner retinitis in immunocompetent gay men.
OBJECTIVE
To describe the features of an unusual syphilitic uveitis syndrome in a cluster of homosexual patients.


METHODS
Retrospective case series.


METHODS
Five consecutive patients diagnosed with syphilitic retinitis in our Melbourne uveitis clinic over a period of 8 months.


METHODS
The case notes of patients diagnosed with syphilitic retinitis were reviewed and the clinical features are presented and discussed.


METHODS
Description of retinal findings and documentation of any associated sequelae.


RESULTS
All patients were homosexual men. Two were human immunodeficiency virus positive. None of the patients had been previously diagnosed with syphilis, although 3 presented with systemic symptoms and signs of secondary syphilis. All patients had marked anterior uveitis and vitritis. All patients had acute retinal arteriolitis and inner retinitis, with distinctive, inner retinal and preretinal white dots. These retinal findings were remarkably similar in all patients, and resolved with little or no sequelae after standard systemic treatment for syphilis, combined with oral prednisolone.


CONCLUSIONS
Syphilitic retinitis may be an increasingly common clinical problem, reflecting the growing incidence of syphilis among homosexual men in Australia. Our patients showed stereotypical ocular and systemic features, which are useful in differentiating this condition clinically from other types of acute posterior uveitis, such as necrotizing viral retinitis.


BACKGROUND
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Wickremasinghe
Sanjeewa
S
The Ocular Immunology Clinic, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Ling
Cecilia
C
Stawell
Richard
R
Yeoh
Jonathan
J
Hall
Anthony
A
Zamir
Ehud
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000175:diagnosis; D018451:Homosexuality, Male; D006801:Humans; D007121:Immunocompetence; D008297:Male; D015864:Panuveitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D031300:Retinal Vasculitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012173:Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013577:Syndrome; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013588:Syphilis Serodiagnosis
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids