Can we consider syphilitic uveitis as neurosyphilis? A retrospective analysis of lumbar puncture results in a cohort of syphilitic uveitis patients

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Abstract

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.

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