Images in Clinical Medicine
Interstitial Keratitis as the Initial Expression of Syphilitic Reactivation
N Engl J Med 2002; 346:1799June 6, 2002
- Article
Figure 1 A 43-year-old woman had sudden visual loss in her left eye. Syphilis had been detected serologically four years before, but she did not complete a course of medical treatment. Examination revealed markedly diminished visual acuity in the left eye. Biomicroscopy showed deep corneal edema and folds on Descemet's membrane only in the left eye (Panel A). Funduscopy revealed no abnormalities. A Venereal Disease Research Laboratory test was negative, and a fluorescent treponemal IgM and IgG antibody absorption test was positive (++++), as was a test for Treponema pallidum hemagglutination (+++; titer, 1:640) and a test for antibodies against borrelia (+). There were no skin lesions. Treatment was begun with topical fluorometholone, intramuscular penicillin G benzathine (2.4 million U once a week for three weeks), and oral doxycycline (100 mg twice daily for two weeks). Six months later, visual acuity of the left eye was normal and biomicroscopy revealed no corneal lesions or scars (Panel B).
Rita Dinis da Gama, M.D.
Manuela Cidade, M.D.
Hospital de São José, 1150-199 Lisbon, Portugal- Citing Articles (2)
