Clinical Pearls & Morning Reports
Published June 4, 2019
Causes of rash that involves the palms include syphilis, psoriasis, reactive arthritis, Kawasaki’s disease, and Rocky Mountain spotted fever. Each of these entities can also cause uveitis, but only syphilis can cause chorioretinitis. Read the latest Case Records of the Massachusetts General Hospital here.
Q: What are some of the features of ocular syphilis?
A: Syphilis does not usually cause scleritis, but it certainly can. Cerebrospinal fluid (CSF) abnormalities are found in the majority of patients with ocular syphilis. Syphilis can produce various forms of uveitis; chorioretinitis is relatively common. Punctate, peripheral retinal spots are especially characteristic of syphilis. A 14-day course of intravenous penicillin is in accordance with Centers for Disease Control and Prevention guidelines for the treatment of syphilis involving the eyes and central nervous system (CNS).
Q: What are some of the potential causes of combined uveitis and CNS disease?
A: Potential causes of combined uveitis and CNS disease include syphilis, primary CNS lymphoma, the Vogt–Koyanagi–Harada syndrome, and multiple sclerosis.
A: The uvea consists of the iris, ciliary body, and choroid. Uveitis is diagnosed when there is inflammation of the uvea, such as chorioretinitis, or when leukocytes are present in the anterior chamber of the eye or in the vitreous humor. Uveitis is classified according to the inflamed portion of the uvea; types include anterior, intermediate, and posterior uveitis, as well as panuveitis. Scleritis occasionally causes uveitis. Causes of uveitis can be divided into broad categories, including infection, immune-mediated disease, reaction to medication, trauma, and syndromes that masquerade as uveitis, such as cancer (usually a B-cell lymphoma).
A: Scleritis is a rare condition. The sclera is the white tunic that surrounds the eye; biopsy of the sclera is rarely performed because of the potential to perforate the globe. Scleritis is often a localized manifestation of a systemic vasculitis. Scleritis is often divided into types. Posterior scleritis is the least common type and the most difficult to diagnose because the posterior sclera can be inflamed without producing any redness. The usual way to assess whether posterior scleritis is present is to obtain ultrasound images of the eye.