Yellowish dots in the retina: a finding of ocular syphilis?

Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.

本研究报道了12例眼梅毒患者出现淡黄色血管周围视网膜前小点的临床征象。2012年3月至10月，我们于圣保罗联邦大学葡萄膜炎专科门诊开展了该类患者的病例系列研究。在确诊梅毒后，对患者行眼底照相及光学相干断层扫描（OCT）以明确该小点的定位，并予静脉注射（IV）结晶青霉素治疗14天。本研究共纳入11例男性患者（占比91.6%），累及19只患眼；患者中位发病年龄为38.1岁，主要临床表现为全葡萄膜炎（7例，占比58.3%），其中4例为双侧受累。10例患者（83.3%）曾口服泼尼松治疗。性病研究实验室（VDRL）血清学检测显示8例患者（66.7%）结果为阳性；而9例送检脑脊液（CSF）样本的患者中，7例（77.8%）的VDRL脑脊液检测结果为阴性。但所有患者的荧光螺旋体抗体吸收试验（FTA-Abs）血清学结果均为阳性，另有8例患者（66.7%）合并人类免疫缺陷病毒（HIV）感染。治疗后，10只患眼（55.6%）的最佳矫正视力（BCVA）较前提升，7只患眼（38.9%）视力无明显变化，仅1只患眼（5.6%）视力下降。尽管目前医学文献尚未将该表现认定为眼梅毒的典型临床表现，但此类表现在临床实践中十分常见。我们认为，该视网膜前小点的出现与密螺旋体感染继发的血管周围炎相关。识别此类表现并牢记梅毒可呈现多种不同的临床表现形式（包括本研究中报道的类型）具有重要临床意义。