title: Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis.
abstract: BACKGROUND
  Syphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis.
  
  
  RESULTS
  This is a retrospective case report with literature review. A 39-year-old Caucasian female presented with a 2-week history of bilateral ocular flashes and left eye pain. Dilated fundus examination revealed mild optic disc edema in both eyes, the right eye more than the left. In the left eye, there was an area of retinal elevation and whitening involving the peripheral retina. Fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography were performed, and laboratory tests were ordered based on the clinical presentation. After rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were positive, syphilitic uveitis was confirmed, and the patient was admitted for a 14-day course of high-dose intravenous penicillin G.
  
  
  CONCLUSIONS
  The first signs and symptoms of syphilis may be ocular, which can lead to a diagnostic challenge. A high index of suspicion is the key for early diagnosis of ocular syphilis. Prompt treatment with intravenous penicillin G is highly effective in resolving the infection.
authors.affiliation: Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA.
authors.forename: Christy Elizabeth
authors.initials: CE
authors.lastname: Benson
authors.affiliation: Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA ; Department of Ophthalmology, Assiut University Hospital, Al Gamaa St, Assiut, 71516 Egypt.
authors.forename: Mohamed Kamel
authors.initials: MK
authors.lastname: Soliman
authors.affiliation: Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Knezevic
authors.affiliation: Tenth People's Hospital, 301 Yanchang Road, Shanghai District, Shanghai, 200072 China.
authors.forename: Daisy Ding
authors.initials: DD
authors.lastname: Xu
authors.affiliation: Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA.
authors.forename: Quan Dong
authors.initials: QD
authors.lastname: Nguyen
authors.affiliation: Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE 68105 USA.
authors.forename: Diana V
authors.initials: DV
authors.lastname: Do
keywords: Chorioretinitis; Panuveitis; Papillitis; Retinitis; Syphilis; Uveitis