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Virology Research Journal | Volume 2
allied
academies
May 18-19, 2018 | Montreal, Canada
2
nd
World Conference on
STDs, STIs & HIV/AIDS
T
he incidence of syphilis is increasing especially among
MSM with HIV. However because of its multitudinous
unusual manifestations, it remains a diagnostic and
therapeutic challenge to the modern era. The case presents
a 25-year-old homosexual male, recently-diagnosed with HIV
who presented with progressive blurring of vision following a
history of pruritic rashes on both lower extremities. Physical
examination shows madarosis, hyperemic conjunctivae
with multiple erythematous macules and papulovesicular
lesions with some collarette scaling over both lower
extremities. During an initial consultation, the Rapid Plasma
Reagin (RPR) was negative with a CD4 count was 34cells/
mm3. The persistence of symptoms prompted consult to
an infectious disease specialist and subsequent referral
to an ophthalmologist. Funduscopy showed a clear media
and hyperemic disc with indistinct disc borders. There are
multiple whitish dots in the retinal mid-periphery. Fluorescin
angiography showed leakage of the optic nerve head
with diffuse areas of retinal vasculitis in the retinal mid-
periphery. A repeat RPR was remarkably reactive at 1:256.
The false negative result during the initial non-treponemal
test therefore demonstrated the
Prozone phenomenon
which occurs in <1% of cases when high titers of antibodies
interferes with the proper formation of the antigen-antibody
lattice network. The history, self-report of unprotected
sexual intercourse and the correlation between rashes,
several diagnostic findings, and a positive Fluorescent
treponemal antibody absorption test yield the diagnosis of
ocular syphilis. Treatment of penicillin G 24M units IV daily
for 14 days was intended. But because of a known history
of penicillin allergy, oral desensitization with penicillin V was
initiated first. In conclusion, clinicians need to remain familiar
with the protean manifestations of syphilis and acquainted
with Prozone effect when necessary. Since syphilis is a great
masquerader, it requires high index of suspicion and should
be included in the differential diagnoses of visual complaints.
e:
leeboydvalenciamd@gmail.comThe Prozone phenomenon in a 25-year-old HIV-positive male with ocular syphilis and allergy to penicillin
Lee-Boyd D. Valencia
and
Ryan M. Llorin
St. Luke’s Medical Center, Philippines