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Published byGyles Wilkinson Modified over 8 years ago
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Hypopyon Uveitis Linda Huang, MD Ronald Rescigno, MD Rutgers, New Jersey Medical School
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Ocular History 58 year old man OS: Pain, redness, decreased vision for one week Denies past medical and ocular history
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First Presentation VA: OD 20/20, OS CF OS: +2 conjunctival injection +4 AC cell, hypopyon, posterior synechiae +3 anterior vitreous cell Fundus: OD within normal OS no view B scan OS: Vitritis, flat retina, normal choroid
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First Presentation Patient sent for: CBC Chemistry ACE RPR/VDRL Blood Cultures PPD Chest X ray
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Follow up after a few weeks He did not get any testing done He went to another clinic and was diagnosed with VKH and started on Prednisone. Taking Prednisone 40mg PO daily
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Follow up Now complaining of decreased vision OD VA: OD CF, OS HM OS: remains unchanged OD: Retinitis involving the posterior pole Retinal arteritis Retinal precipitates Pseudohyopyon
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Follow up Initial Workup reordered Serum VDRL 1:4096 FTA+ CSF VDRL + HIV+ CD4 1,253 cells/mm
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Treatment IV penicillin G 4 million units every 4 hours for two weeks
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Follow up 3 weeks after treatment VA OD 20/20, OS CF Fundus exam OD returned to baseline
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Final Diagnosis Neurosyphilis with bilateral panuveitis in an HIV positive patient
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Conclusion Clinical manifestations of syphilis are highly variable Can mimic many other ocular disorders Often leads to misdiagnosis and delay in treatment High rates of concurrent HIV infections Important to consider in your differential diagnosis of hypopyon
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