Panuveitis as the Initial Manifestation of Syphilis with Concurrent HIV Infection

以葡萄膜炎為初始表徵之人類免疫缺乏病毒感染合併梅毒感染

陳南詩(Nancy Chen) ； 蔡榮坤(Rong-Kung Tsai) ； 許明木(Min-Muh Sheu)

《中華民國眼科醫學會雜誌》 50卷1期 (2011/04) Pp. 136-140

https://doi.org/10.30048/ACTASOS.201104.0019

摘要

目的：本文報告一位人類免疫缺乏病毒感染合併梅毒感染的病患，以單眼葡萄膜炎為他的初期表徵。方法：病例報告。結果：一位25歲男性近兩個月來有右眼視力逐步減退繼發右眼疼痛的現象，經眼科醫師檢查診斷為右眼葡萄膜炎。入院後，血清學報告顯示梅毒檢查呈陽性；我們同時抽取了病患右眼的前房液於暗視野顯微鏡下觀查，也偵測到螺旋體；隨後檢驗報告證實了該病患同時感染了人類免疫缺乏病毒，且CD4數目低下。確診為人類免疫缺乏病毒感染合併梅毒感染後，病患接受盤尼西林注射和口服抗病毒藥物治療。診斷之初，玻璃體發炎令視網膜完全被遮蔽；開始治療後四天，右眼眼底可見玻璃體內些許串珠狀的積膿及視網膜血管炎以霜狀或滴臘狀的滲出物表現。盤尼西林治療完成後，葡萄膜炎狀況明顯改善，病人的右眼視力也進步了；經過八個月持續追蹤，病患不曾再發生葡萄膜炎。結論：我們報告的這位眼部併神經性梅毒病患，在入院診療之初並不知道自己感染了人類免疫缺乏病毒及梅毒；經由詳盡的檢查，我們才得以確診，及時的予以治療。因此身為眼科醫師，對於患有梅毒性葡萄膜炎的病患，應考慮同時感染人類免疫缺乏病毒的可能性。

並列摘要

Purpose: To report a patient with panuveitis as the initial presentation of syphilis and concurrent HIV infection. Method: Retrospective single case report. Result: A 25-year-old male suffered from progressively blurry vision in his right eye for 2 months, which ultimately became associated with ocular pain. Ophthalmic examination revealed that he had panuveitis (od). Laboratory tests for syphilis were positive with a rapid plasma reagin of 1:1028 and a Treponema pallidum hema-agglutination of 1:10240. In addition, spirochetes were found in the patient's aspirated aqueous humor using dark field microscopy. Subsequent tests for HIV were positive and revealed a CD4 count of 93 cells/mm^3. The patient received full dose of intravenous penicillin G in addition to highly active antiretroviral therapy. Several small round exudations in vitreous and frosted angiitis with a candle-wax-like appearance, which resolved 10 days later, were able to be observed while the anterior chamber and vitreous reaction improved. After the treatment, the panuveitis subsided, and the patient's vision improved in his right eye. During the eight months follow-up, there was no syphilitic uveitis recurrence. Conclusion: We report a patient with ocular syphilis and reveal a previously unknown HIV infection. The diagnosis of a concurrent infection by both T. pallidum and HIV was detected by performing a thorough examination. Patients with ocular syphilis should be screened for HIV co-infection in order to get early treatment.

並列關鍵字

Panuveitis ； ocular syphilis ； HIV