13 Responses

1. Also considered Differential Diagnosis (DD):

   1. Neurosyphilis (ocular syphilis)

   2. Tuberculous uveitis

   3. Viral retinitis (e.g., HSV, VZV, CMV)

   4. Sarcoidosis

   5. Behçet’s disease

   6. Lupus-related retinal vasculitis

   7. HIV-associated uveitis

   8. Multiple sclerosis–associated uveitis

   9. Lyme disease

   10. Toxoplasmosis uveitis

2. ✅ Differential Diagnosis for Bilateral Uveitis + Retinal Vasculitis + Papilledema + Risky Sexual Behavior

   This patient’s findings suggest ocular inflammation + optic nerve involvement.
   Given the sexual history and TP-PA positivity, ocular syphilis is likely — but a differential list is still important.

   1. Infectious Causes
   a. Syphilis (Ocular Syphilis) — MOST LIKELY

   Consistent with uveitis, retinal vasculitis, papilledema

   Risk factor: unprotected sexual contact

   Positive TP-PA

   b. Tuberculosis

   Granulomatous uveitis

   Retinal vasculitis (peri-phlebitis)

   May mimic syphilis

   c. Viral Infections

   Herpes simplex virus (HSV)

   Varicella zoster virus (VZV)

   CMV (especially in immunocompromised)
   Cause necrotizing retinitis, uveitis, optic neuritis.

   d. Toxoplasmosis

   Focal necrotizing retinochoroiditis

   Can cause panuveitis

   e. HIV Retinopathy / Opportunistic Infections

   Cotton-wool spots

   CMV retinitis

   2. Autoimmune / Inflammatory Conditions
   a. Sarcoidosis

   Granulomatous uveitis

   Retinal vasculitis

   Optic nerve swelling

   b. Behçet’s Disease

   Painful uveitis

   Retinal vasculitis (hallmark)

   Oral/genital ulcers (ask history)

   c. Systemic Lupus Erythematosus (SLE)

   Retinal vasculitis

   Optic neuritis

   Uveitis uncommon but possible

   d. HLA-B27 Associated Uveitis

   Ankylosing spondylitis

   Psoriatic arthritis

   Reactive arthritis

   IBD-associated

   3. Neurologic Causes (producing papilledema + ocular symptoms)
   a. Intracranial Hypertension

   Idiopathic intracranial hypertension (IIH)

   Mass lesions, venous sinus thrombosis

   b. Optic Neuritis (Demyelinating Diseases)

   Multiple sclerosis

   Neuromyelitis optica spectrum disorder (NMOSD)

   4. Masquerade Syndromes
   a. Intraocular lymphoma

   Chronic uveitis not resolving

   Vitreous opacities

   Retinal infiltrates

   b. Leukemia

   Retinal hemorrhages, optic disc swelling

   ⭐ Most Probable Final Diagnosis

   Ocular Neurosyphilis (because of):
   ✔ Bilateral uveitis
   ✔ Retinal vasculitis
   ✔ Papilledema
   ✔ Positive TP-PA
   ✔ High-risk sexual exposure

   CSF VDRL testing is appropriate to confirm neurosyphilis.

3. Occular syphilis need to do lumber punture and treated as intravenous C Penicillin is preferred.

4. Ideally this is Neurosyphlis, by the fact that there is ophthalmic involvement characterized by examination findings of; bilateral Uvietis, retinal vasculitis, papilloedema secondary to ocular inflammation. Therefore this client requires promptly to be treated with effective antibiotics preferably Penicillin G like; Benzathine penicillin 2.4MU Intramascularly once weekly for a course of 3weeks and addition of anti-inflammatory therapy would serve better progonsis for the patient from inflammatory symptoms either with the use of steroids or NSAIDS post 4days after the induction phase of antibiotics treatment.

5. Syphils

6. Hi,
   This is sight-threatening, but it can spread to other nerve systems.
   Sexual education is important for every one.

7. Ocular syphilis can occur at any stage of syphilis infection and can lead to severe complications, including blindness, if not treated promptly. It’s treated with intravenous or intramuscular antibiotics, typically penicillin, the standard treatment for syphilis. This case underscores the importance of considering STIs in the differential diagnosis of ocular inflammation and the need for a thorough sexual history as part of the patient evaluation.

8. Neurosyphllis

9. Best case

10. A Neurosyphilis

11. No of those above mentioned( This presented as Sexual transmitted case, it’s better to be seriously publishing the Diseases, let’s wait for others if could be registered !).

12. Thank you for all the cases presented and the methods of prevention and treatment. This brings back our complaint about diseases and corrects our mistakes and the goals of our treatment for patients.

13. Thanks