Ocular Jarisch-Herxheimer reaction causing a transient sub-foveal lesion in ocular syphilis
Authors: Christine E. Ashenhurst 1, Patrick Mitchell2, Michael Y. K. Mak3, Micheal T. Kryshtalskyj2. 1University of Victoria, 2University of Calgary, 3McGill University.
Author Disclosures: C.E. Ashenhurst: None. P. Mitchell: None. M.Y.K. Mak: None. M.T. Kryshtalskyj: None.
Abstract Body:
Purpose: To report a novel progression of ocular syphilis where a Jarisch-Herxheimer reaction to intravenous penicillin resulted in the development of a novel, transient retinal lesion.
Study Design: Case Report
Methods: A review of patient’s clinical records, history, referrals, and imaging in addition to the relevant literature was conducted.
Results: A 51-year-old female presented to emergency with a one-month history of phosphenes, palinopsia and patchy scotomas in the setting of a maculo-papular rash and new sexual partner. Clinical examination revealed uncorrected visual acuity of 20/20 oculi uterque (OU), vitreous cells, as well as bilateral placoid chorioretinal lesions and disc edema. Syphilis enzyme immunoassay (EIA) and rapid plasma regain (RPR) testing were positive and intravenous penicillin G was administered. Three days post intravenous therapy, her vision deteriorated to 20/400 in the right eye, with worsening papilledema and vitritis, as well as a new, yellow, raised sub-foveal lesion despite a reduction in size of the placoid lesion. Although there was acute worsening of her ocular status, the patient did not experience any other classic symptoms of systemic Jarisch-Herxheimer reaction. By one month, her sub-foveal lesion, disc swelling, and placoid lesions had nearly resolved, and at her ten-week follow-up, her visual acuity was 20/20.
Conclusions: To our knowledge, this report of a transient retinal lesion post Jarisch-Herxheimer reaction is novel. We hypothesize this lesion to represent clumping of degenerated photoreceptors from heightened outer-retinal inflammation from a syphilitic ocular Jarisch-Herxheimer reaction.
