Ocular symptoms as atypical presentation of re-emerging pathogen
Abstract
We present an unusual case of a patient presenting with blurry vision, and rapid visual loss over two days as their main symptom. Examination demonstrated a maculopapular rash, which the patient had previously dismissed. Ophthalmology examination showed significantly reduced visual acuity in left eye 1.06 log MAR and features consistent with uveitis. A broad differential diagnosis was considered. Investigations showed Treponema pallidum IgM positive, VDRL/ RPR positive, titre 1:32. HIV negative. Lumbar puncture was performed with CSF PCR treponema pallidum positive VDRL 1:80. Treated with IV benzathine penicillin 2.4g six times a day, for fourteen days, in addition to high dose steroids. Rapid improvement in visual acuity and end of treatment, and resolution of rash. Partner also successfully treated.
