眼科医生在迅速诊断梅毒中的作用:揭露伟大的模仿者。

IF 2.6 4区 医学 Q2 OPHTHALMOLOGY
Luca De Simone, Francesca Ceccarelli, Pietro Gentile, Elena Bolletta, Fabrizio Gozzi, Vanessa Ferraro, Mario Romano, Carlo Nucci, Luca Cimino
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引用次数: 0

摘要

目的:梅毒是一种全身性传播感染,通常与自身免疫和神经系统疾病相似,可导致诊断延迟。我们描述了一系列四例眼部梅毒患者,最初被误诊为全身性炎症,以强调眼科医生在早期发现和治疗中的作用,从而防止不可逆的视力损害。方法:回顾性分析2022 - 2024年4例眼梅毒患者,这些患者最初被误诊为自身免疫性疾病或神经系统疾病,因而不恰当地采用免疫抑制治疗。患者接受了全面的眼科检查,包括最佳矫正视力、裂隙灯生物显微镜、眼底成像、光学相干断层扫描和视网膜血管造影。进行梅毒血清学检查,治疗包括静脉注射青霉素G或头孢曲松(青霉素过敏患者)。结果:所有患者梅毒检测呈阳性,HIV筛查呈阴性。最初的误诊包括系统性结节病、多发性硬化症、牛皮癣样皮肤病变或未知的炎症,并接受不必要的免疫抑制治疗。眼部表现从肉芽肿性全葡萄膜炎到视网膜血管炎、placoid脉络膜视网膜炎和黄斑水肿不等。抗生素治疗可显著改善临床,但患者表现出不可逆的损害,如视力下降、持续性色觉丧失、视网膜萎缩和不可逆的光感受器损伤。结论:梅毒仍是一种大模仿者,常被误诊为非传染性全身性疾病。眼科医生在识别眼部表现和启动适当的血清学检测方面发挥着关键作用。延迟诊断会增加不可逆损伤的风险。鉴于发病率不断上升,提高认识和跨学科合作对于确保及时诊断和管理至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Role of the Ophthalmologist in the Prompt Diagnosis of Syphilis: Unmasking the Great Mimicker.

Purpose: Syphilis is a systemic sexually transmitted infection that often mimics autoimmune and neurological disorders, which can lead to diagnostic delays. We describe a series of four patients affected by ocular syphilis initially misdiagnosed as a systemic inflammatory condition to highlight the ophthalmologist's role in early detection and management, thereby preventing irreversible visual impairment.

Methods: We retrospectively reviewed four cases of ocular syphilis from 2022 to 2024, which were initially misdiagnosed as autoimmune or neurological diseases and thus inappropriately treated with immunosuppressive therapy. The patients underwent a full ophthalmic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, fundus imaging, optical coherence tomography, and retinal angiography. Syphilis serologies were performed, and treatment included intravenous penicillin G or ceftriaxone (for penicillin-allergic patients).

Results: All patients tested positive for syphilis, with negative HIV screening. Initial misdiagnoses included systemic sarcoidosis, multiple sclerosis, psoriasis-like skin lesions, or unknown inflammatory conditions and were treated with unnecessary immunosuppressive therapy. Ocular findings varied from granulomatous panuveitis to retinal vasculitis, placoid chorioretinitis, and macular edema. Antibiotic therapy led to significant clinical improvement, but patients exhibited irreversible damage, such as decreased visual acuity, persistent color vision loss, retinal atrophy, and irreversible photoreceptor damage.

Conclusion: Syphilis remains a great mimicker, frequently misdiagnosed as non-infectious systemic disease. Ophthalmologists play a critical role in identifying ocular manifestations and initiating appropriate serological testing. A delayed diagnosis increases the risk of irreversible damage. Given the rising incidence, greater awareness and interdisciplinary collaboration are essential to ensure timely diagnosis and management.

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来源期刊
CiteScore
6.20
自引率
15.20%
发文量
285
审稿时长
6-12 weeks
期刊介绍: Ocular Immunology & Inflammation ranks 18 out of 59 in the Ophthalmology Category.Ocular Immunology and Inflammation is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and vision scientists. Published bimonthly, the journal provides an international medium for basic and clinical research reports on the ocular inflammatory response and its control by the immune system. The journal publishes original research papers, case reports, reviews, letters to the editor, meeting abstracts, and invited editorials.
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