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Celecoxib for recurrent sclerouveitis after syphilitic panuveitis. A case report
© The Author(s) 2011
Received: 27 May 2011
Accepted: 1 July 2011
Published: 22 July 2011
To report a case of recurrent ocular inflammation after optimal therapy of bilateral syphilitic panuveitis responding to oral celecoxib.
A case report was conducted.
A 76-year-old man presented with painful blurry vision in both eyes. Ocular examination disclosed bilateral panuveitis. Serological testing confirmed blood and cerebrospinal fluid syphilitic involvement. After 2 weeks of intravenous penicillin therapy, recurrent episodic sclerouveitis was observed.
Ocular inflammation after healing of infectious uveitis is a rare ophthalmic sequela. In an immunocompetent patient, either re-infection or immune uveitis should be evoked. Non-steroidal therapeutic options, as celecoxib, could be a good option of treatment in such immune cases.
Syphilis is experiencing an extreme increase of its incidence in Europe and the USA since the early 2000s . Although penicillin is considered an excellent effective therapy against Treponema pallidum, patients HIV positive with cerebrospinal fluid involvement can fail treatment . In immunocompetent patients, either immune uveitis or syphilitic re-infection should be evoked if ocular inflammation is observed after optimal therapy.
We report a syphilitic panuveitis presenting recurrent ocular inflammation after correct treatment with penicillin, treated with celecoxib, a nonsteroidal anti-inflammatory drug selective for cyclooxygenase-2.
Interaction of T. pallidum with the host's immune system stimulates humoral and cellular immunity. T. pallidum produces lipoproteins on the outer membrane that interact with lipopolysaccharide-binding proteins, inducing the expression of inflammatory mediators via CD14 and toll-like receptor 2 recognition. Treponemes also possess glycolipids linked to the outer membrane that resemble bacterial lipopolysaccharide. These glycolipids induce cellular activation by releasing pro-inflammatory cytokines, mainly tumoral necrosis factor alpha , even after successful penicillin treatment.
Recurrent ocular inflammation after infectious uveitis treatment is a rare ocular sequela. In the immunocompetent host, such as our patient, it can occur due to a syphilitic re-infection or to an immune process, which may be caused by antigenically inert treponema cell surface. To our knowledge, this is the first report of an immune response after optimal treatment of ocular syphilis at an immunocompetent host.
NSAIDs have an anti-chemotactic activity and modulate both humoral and cellular pathways. Systemic NSAIDs such celecoxib are known to control ocular inflammatory processes such chronic iridocyclitis or recurrent acute anterior uveitis [4, 5], being suitable and sparing-steroids option of therapy in these cases.
In conclusion, the outer treponema surface may play a role in immune responses observed after syphilis treatment. We present the first case reported in literature of immune sclerouveitis after neurosyphilis treatment treated successfully with celecoxib.
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