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Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 824-825

Syphilis induced inflammatory combined central retinal vein and artery occlusion


Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission23-Mar-2022
Date of Acceptance19-May-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Basavaraj Tigari
Assistant Professor, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_761_22

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  Abstract 


Keywords: CRAO, CRVO, ocular syphilis, optic neuritis


How to cite this article:
Markan A, Singh R, Dogra M, Tigari B. Syphilis induced inflammatory combined central retinal vein and artery occlusion. Indian J Ophthalmol Case Rep 2022;2:824-5

How to cite this URL:
Markan A, Singh R, Dogra M, Tigari B. Syphilis induced inflammatory combined central retinal vein and artery occlusion. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Oct 6];2:824-5. Available from: https://www.ijoreports.in/text.asp?2022/2/3/824/351212



A 48-year-old man presented with sudden onset diminution of vision in the left eye (LE) from the past 2 weeks. Best-corrected visual acuity (BCVA) in the right eye (RE) was 6/6 and LE was the perception of light (PL). Examination revealed granulomatous keratic precipitates and 2 + cells in the anterior chamber. Fundus examination revealed vitritis with media grade 2+, disc hyperemia, and few retinal hemorrhages in the mid periphery associated with increased venous dilation and tortuosity suggestive of impending central retinal vein occlusion (CRVO). In addition, there was the presence of retinal whitening at the macula along with box caring or segmentation of the blood column in both retinal arteries and veins [Figure 1]a. Swept-source optical coherence tomography (OCT) through the foveal center showed the presence of full-thickness retinal edema and an inner retinal hyperreflectivity with preservation of outer retinal layers [Figure 1]b. Clinical and OCT findings were suggestive of an impending CRVO with central retinal artery occlusion (CRAO).
Figure 1: (a) Fundus photograph showing vitritis, retinal whitening at macula, venous dilatation and tortuosity, few retinal hemorrhages in mid periphery, and box caring of both arteries (red) and veins (blue). These findings were suggestive of inflammatory impending CRVO along with CRAO. (b) Swept-source OCT showing full-thickness retinal edema at macula with inner retinal hyperreflectivity. Presence of full-thickness retinal edema is suggestive of edema due to CRVO

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Systemic evaluation revealed the presence of multiple erythematous papular skin lesions on the chest and tongue [Figure 2]a and [Figure 2]b. Routine blood investigations were normal. Serological testing for syphilis revealed a positive nontreponemal (VDRL, titers 1:32) and treponemal test (TPHA). Dermatological consultation was taken and skin lesions were suggestive of syphilitic lesions.
Figure 2: Multiple erythematous maculopapular lesions on chest (a)and tongue (b) due to syphilis

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  Discussion Top


Retinal vasculitis is a known complication of ocular syphilis.[1] Central retinal vessel involvement can be attributed either to direct localized vasculitis or compression from an inflamed optic nerve head. Though direct infiltration of spirochete into optic nerve head is rare, this could possibly be an alternate mechanism in this case.[2] Khan et al.[3] has reported a case of unilateral optic neuritis and central retinal vasculitis, owing to localized vasculitis. Also, CRAO in the case of CRVO can happen from the functional blockade in arterial circulation secondary to venous stagnation.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yokoi M, Kase M. Retinal vasculitis due to secondary syphilis. Jpn J Ophthalmol 2004;48:65–7.  Back to cited text no. 1
    
2.
Smith JL, Byrne SF, Cambron CR. Syphiloma/gumma of the optic nerve and human immunodeficiency virus seropositivity. J Clin Neuroophthalmol 1990;10:175–84.  Back to cited text no. 2
    
3.
Khan MS, Kuruppu DK, Popli TA, Moorthy RS, Mackay DD. Unilateral optic neuritis and central retinal vasculitis due to ocular syphilis. Retin Cases Brief Rep 2020;14:35–8.  Back to cited text no. 3
    
4.
Hayreh SS. Central retinal artery occlusion. Indian J Ophthalmol 2018;66:1684–94.  Back to cited text no. 4
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