Sympathetic Ophthalmia

A patient presented with blurry vision in the right eye for one day. He had a history of remote retinal detachment repair in the left eye due to blunt trauma. Slit lamp examination revealed anterior uveitis in the right eye and prolapsed iris tissue in an old surgical wound in the left. He was started on topical steroid drops OD. He presented back for follow up with new vitritis and numerous choroidal lesions in both eyes. ICG demonstrated numerous diffuse lesions OU, consistent with a diagnosis of sympathetic ophthalmia (SO). A full uveitis laboratory evaluation was sent, and he was started on oral prednisone. However, labs were positive for FTA antibodies with a non-reactive RPR, concerning for syphilis. Given the ICG findings, HLA haplotype consistent with SO, and iris prolapse in the fellow eye, SO was the likely diagnosis. However, given possible need for long term immunosuppression in SO, he was referred to the ER for empiric IV penicillin treatment for CNS syphilis. Subsequently, the patient was started on immunosuppressive therapy. His inflammation resolved and he recovered vision in the right eye.

Presentation Date: 08/19/2021

Issue Date: 09/10/2021