A Case of Adult-onset Presumed Congenital Syphilitic Keratitis: A Multidisciplinary Management Approach.
Melody Y Zhou, Thomas L Steinemann
✦ AI-curated · Sources linked
Case in brief
A 28-year-old man had an 11-year history of progressive bilateral redness, tearing, and visual decline. Examination showed bilateral interstitial keratitis; treponemal serology was positive and nontreponemal serology negative, supporting presumed late congenital syphilis. Intravenous penicillin G and topical corticosteroids were followed by refractory inflammation, stromal scarring, corneal thinning, and perforation requiring a tectonic patch graft. Inflammatory flares continued despite sustained steroid therapy and negative nontreponemal serologies. Prolonged multidisciplinary care, including rigid corneal and scleral contact lens fitting, was needed for visual rehabilitation.
What made this case unusual
The presumed congenital syphilitic keratitis first presented in adulthood, and the course progressed to corneal perforation despite antimicrobial treatment and sustained corticosteroid therapy.
Diagnostic / clinical pearl
In adult-onset interstitial keratitis, positive treponemal with negative nontreponemal serology may support presumed late congenital syphilis, but the diagnosis may remain uncertain and inflammation can persist despite treatment.
Why it matters
Refractory inflammation, structural corneal complications, and visual rehabilitation may require sustained coordination among ophthalmology, infectious disease, and optometry.