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Título

NEUROSYPHILIS ASSOCIATED WITH INTERMEDIATE UVEITIS – A CASE REPORT

Resumo

Female patient, 80 years old, from Rio de Janeiro (RJ), attended an ophthalmological consultation at Hospital Federal da Lagoa on 11/10/2023 reporting hypoactivity, asthenia and sensation of an ocular foreign body. History of cataract surgery in both eyes, diabetes mellitus on regular medication and history of gestational syphilis not adequately treated.
On ophthalmological examination, uncorrected visual acuity (VA) was 20/100 in the right eye (RE) and counting fingers at two meters in the left eye (LE), intraocular pressure (IOP) 10/10 mmHg and in refraction 20/50 in the RE and 20/ 200 in LE. Biomicroscopy revealed moderate blepharitis, mild punctate keratitis and intense vitreous cellularity (2+/4+) under direct optical section illumination.
An OCT was requested, which revealed the presence of intraretinal cysts and subretinal fluid with a cystoid macular edema pattern in both eyes (appendix 1). Fluorescein angiography revealed hyperfluorescent optic nerve and macula due to extravasation and hyperfluorescent spots in the posterior pole and periphery – suggestive of multifocal choroiditis (appendix 2). Topical corticosteroids every 4 hours and topical NSAIDs every 8 hours were started and infectious screening was requested, which revealed VDRL reagent with positive FTA abs. Patient underwent lumbar puncture with the presence of proteinorrhachia in the cerebrospinal fluid. The approach given the diagnosis was the introduction of Crystalline Penicillin 4,000,000 IU intravenously every 4 hours for 14 days and oral corticosteroids 40 mg/day - 1 mg/kg/day with a reduction of 10 mg every 7 days. Up to this point in the study, the patient has experienced progressive improvement in visual complaints, a significant reduction in vitriitis and an exponential reduction in the cystoid macular edema and angiographic pattern.

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