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Can we consider syphilitic uveitis as neurosyphilis? A retrospective analysis of lumbar puncture results in a cohort of syphilitic uveitis patients
Author(s) -
LHOIR S,
WILLERMAIN F,
JANSEN J,
LIBOIS A,
VAN CALSTER J,
CASPERS L,
MAKHOUL D
Publication year - 2013
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2013.s061.x
Subject(s) - medicine , neurosyphilis , uveitis , lumbar puncture , syphilis , retrospective cohort study , csf albumin , cerebrospinal fluid , serology , cohort , gastroenterology , human immunodeficiency virus (hiv) , ophthalmology , immunology , antibody
Purpose To investigate the cerebral spinal fluid (CSF) composition of patients with syphilitic uveitis (SU) and classify SU as neurosyphilis or not. Methods Retrospective study of SU patients from 2 Belgian university centers from 2003 to 2012. The diagnosis of SU was based on a positive syphilitic serology (FTA‐Abs and RPR) and a treatment response. Charts were reviewed for uveitis anatomical location, HIV status, serum RPR and CSF findings. Diagnosis criteria for neurosyphilis were: positive CSF‐RPR and/or CSF‐white blood cells (WBC) ≥ 5/μl for HIV‐, and positive CSF‐RPR and/or CSF‐WBC ≥ 20/μl for HIV+. Results 20 patients were included. 5 were HIV+. There were 3 papillitis, 10 posterior uveitis and 7 panuveitis. Cells were found in CSF in all patients (mean 40/μl) and were predominantly lymphocytes. Mean CSF‐proteins, lactate and glucose were 0.57g/l, 17mg/dl and 62mg/dl respectively. No differences were found between HIV+ and – patients. CSF‐RPR was + in 2/5 (40%) of HIV+ and in 11/15 (73%) of HIV‐ with no statistical difference. Conclusion In our series, all patients had a CSF cellular reaction, mostly lymphocytic. This strongly suggests that the blood brain barrier is disrupted during syphilitic uveitis. However, a positive RPR was not observed in all CSF. Despite this discrepancy, following our criteria, 100% of our patients could be classified as neurosyphilis.