Skip to main page content

Ocular Jarisch-Herxheimer reaction causing a transient sub-foveal lesion in ocular syphilis

My Session Status

What:
Paper Presentation | Présentation d'article
When:
2:20 PM, Sunday 18 Jun 2023 (5 minutes)
Where:
Québec City Convention Centre - Room 308 B | Salle 308 B

 

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.

 

My Session Status

Send Feedback

Session detail
Allows attendees to send short textual feedback to the organizer for a session. This is only sent to the organizer and not the speakers.
To respect data privacy rules, this option only displays profiles of attendees who have chosen to share their profile information publicly.

Changes here will affect all session detail pages