A Case of Acute Interstitial Keratitis in a Patient with Acquired Syphilis

Tae Jin Kim; Han Gyul Yoon; Jae Woong Koh

doi:10.3341/jkos.2017.58.2.226

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Kim, Yoon, and Koh: A Case of Acute Interstitial Keratitis in a Patient with Acquired Syphilis

Original Article

J Korean Ophthalmol Soc 2017;58(2):226-229.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.226

A Case of Acute Interstitial Keratitis in a Patient with Acquired Syphilis

Tae Jin Kim, M.D., Han Gyul Yoon, M.D., Jae Woong Koh, M.D., PhD

Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea

Address reprint requests to Jae Woong Koh, MD, PhD Department of Ophthalmology, Chosun University Hospital #365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: 82-62-220-3190, Fax: 82-62-225-9839 E-mail: ophkoh@hanmail.net

This study was presented as an e-poster at the 115th Annual Meeting of the Korean Ophthalmological Society 2016.

This study was supported by research funds from Chosun University Hospital 2016.

Received 13 October 201617 November 2016 Accepted 17 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis.

Case summary

A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epi-thelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABS IgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient’s right eye improved to 20/20.

Conclusions

We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an im-munocompetent patient.

Keywords: Acquired syphilis, Interstitial keratitis, Ocular syphilis, Treponema pallidum

References

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Figure 1.

Anterior segmentation photo of deep stromal opacifications, patchy in outline (arrows), and accompanied by the presence of new vessels on cornea of the right eye at first visit. (A) Using blue filter. (B) Without using filter.

Figure 2.

Cornea central thickness increased on the right eye (576 μ m). (A) Compared to the left eye (479 μ m), and (B) in anterior segment optical coherence tomography (AOCT) at first visit.

Figure 3.

Anterior Segmentation photo of the right eye that the opacity and edema of cornea regressed after 2 weeks (arrows). (A) Without using filter. (B) Using blue filter.

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