Bilateral hypopyon in syphilitic uveitis
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Hypopyon is a relatively uncommon presentation among patients with uveitis. Its incidence in patients with uveitis is estimated to be 8.57 per 1000 person-years. It is characterized by a vigorous inflammatory reaction that leads to white blood cell precipitation in the anterior chamber. It is typically present in patients with endophthalmitis, uveitis, or malignancy. In patients with noninfectious uveitis, the most common etiologies for a hypopyon upon presentation include Behçet's disease and having the HLA-B27 haplotype. Patients who develop hypopyon and do not have a recent history of penetrating trauma, infection, or surgery require a complete medical evaluation including particular attention to fever,
rashes, oral ulcers, and arthritis.

A 38-year-old male presented with a 2-day history of bilateral progressive visual loss, conjunctival hyperemia, and photophobia. Initial ophthalmologic examination revealed bilateral hypopyon and vitritis that limited the examination of the posterior segment. The physical exam revealed cervical lymphadenopathy, glossal leukoplakia, erythematous maculae on the hard palate, erythematous macular lesions on both palms, onychodystrophy, onycholysis, and psoriasiform plaques on both plantar surfaces, testicular tenderness, and hypopigmented patches on the scrotal and perianal skin. A therapeutic and diagnostic vitrectomy was performed on the right eye, and the intraoperative findings were consistent with severe vitritis and pre-retinal precipitates. The cytopathologic analysis of the right vitreous revealed a mixed inflammatory process composed of lymphocytes, histiocytes, and neutrophils in a proteinaceous background. Laboratory testing revealed positive serum RPR, CSF FTA-Abs and VDRL, and HIV serology. Treatment with a 2-week course of intravenous penicillin G 4 million units every 4 hours and topical corticosteroids resulted in complete resolution of the uveitis.

Bilateral hypopyon uveitis may be a rare presentation of syphilitic uveitis. As with most forms of uveitis, syphilis should be considered in the differential diagnosis of patients presenting with bilateral hypopyon.