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Ocular syphilis can develop shortly after acquiring the infection.
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Macular star is a rare presentation of syphilis.
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Complete resolution of macular exudates occurs after treatment.
We describe a case of a male patient aged 35 years who presented with 2 days of blurred vision in the left eye (LE), with no other symptoms. He reported a history of risky sexual contacts 7 weeks before the onset of symptoms.
Visual acuity (VA) in the LE was 0.05. The slit lamp examination showed mild cellularity (Tyndall+) with no other findings. Fundoscopy showed papillary edema in the LE with multiple hemorrhages and superior vasculitis, as well as exudates forming a macular star.
An extensive work-up was performed, including detailed anamnesis and laboratory tests, which showed syphilitic serology positiveness. The rapid plasma reagin titers at diagnosis were 1/8 and the TPPA 1/5120.
The patient was treated with intravenous aqueous crystalline penicillin G 4 million units every 4 hours for 14 days, as well as oral prednisone. He achieved a full recovery of VA 1 month after starting the antibiotic treatment.
Syphilis is a sexually transmitted disease that may have many ocular manifestations [
], retinal detachment, etc. To the best of our knowledge, this is the first documented case of a syphilitic macular star. The differential diagnosis of macular star is wide, including cat-scratch disease, Lyme disease, and toxoplasmosis [
In the image (Fig. 1), we can see an optic nerve edema (white arrow), hemorrhages temporal to the macula (green circles), vasculitis in the superior veins (black circle), and a macular star (yellow arrow).
Fig. 1(a) Optic nerve edema (white arrow). (b) Hemorrhages temporal to the macula (green circles). (c) Vasculitis in the superior veins (black circle). (d) Macular star (yellow arrow).
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