비감염결절성 및 진균성공막염으로 오인되었던 매독성공막염 1예

Abstract

Purpose: To report a case of syphilitic scleritis initially misdiagnosed as noninfectious nodular or fungal scleritis. Case summary: A 63-year-old female, who had severe headaches and ocular pain in her left eye despite treatment with topicaland oral NSAIDs for the past 4 months, was transferred from a local clinic. The patient had a history of pterygium excision in thesame eye 4 years prior. Upon presentation, she had a scleromalacia with calcified plaque at the nasal conjunctiva. An erythematousnodular elevated lesion was observed in the superonasal sclera. Microbiological smear and cultures were performed toexclude infectious scleritis. Under the suspicion of noninfectious nodular scleritis, the patient was prescribed topical oral steroidand oral NSAIDs. Candida parapsilosis was identified by the microbiological culture. Under the suspicion of fungal scleritis, oralfluconazole and topical amphotericin B were administered, but the lesions did not improve. On the 23rd day of treatment, we discoveredthe patient had a history of syphilis. The serology test was negative for RPR and FTA-ABS IgM but positive for FTA-ABSIgG. Under the suspicion of syphilitic scleritis, oral doxycycline (200 mg bid) was administered and benzathine penicillin M (2.4million units) was injected intramuscularly 3 times at 1-week intervals. After the doxycycline and benzathine penicillin therapy,the pain and nodular erythematous lesions were completely resolved. Conclusions: As shown in this case, syphilitic scleritis should be considered when the patient is resistant to other conventionaltreatments and shows positive serological tests for syphilis. This is important because syphilitic scleritis is usually aggravated bysteroid treatment but can be cured by proper anti-syphilitic chemotherapy.