TWO OCULAR SYPHILIS CASES DIAGNOSED WITHIN A YEAR AT A RURAL SECONDARY CARE CENTER Taylor Dartez, Donnell White, III, Christopher Chedid; Louisiana State University School of Medicine, New Orleans, LA.
Introduction: Ocular syphilis is a rare but serious presentation of Treponema pallidum infection, often manifesting during early stages of neurosyphilis. Diagnosis may be delayed due to its similarity to other ocular conditions like ocular sarcoidosis and ocular tuberculosis, complicating treatment. The following cases underscore the importance of prompt diagnosis, treatment, and the significance of multiple ocular syphilis cases diagnosed in a rural secondary care setting within one year. Case: Patient 1: A 44-year-old male with no known medical history presented with progressive vision loss over 1-2 months, with intermittent “foggy” vision for 2-3 months; he noted a painless penile lesion 8-9 months prior, which had resolved but reappeared 3-4 weeks before presentation. His rapid-plasma reagin (RPR) titers were positive at 1:64. His visual symptoms began improving on day 3 of intravenous antibiotic administration, with progressive relief of symptoms until discharge on day 14. Patient 2: A 37-year-old male with congenital cataracts, heart disease, and poorly controlled glaucoma presented with bilateral blindness following a 2-week history of worsening vision;
these symptoms began in the left eye. He also reported severe frontal headaches associated with nausea. His RPR titers were positive at 1:64, and his visual symptoms subjectively began improving on day 1 of intravenous antibiotic administration. This patient left against medical advice on day 8, reporting nearly full symptom improvement. Discussion: Ocular syphilis is a manifestation of neurosyphilis where the infection affects the eyes, leading to conditions such as uveitis, retinitis, and optic neuritis. This can result in symptoms ranging from blurred vision and eye pain to severe visual impairment. Once identified, ocular syphilis is treated with a 14-day course of intravenous penicillin G, following the same treatment protocol as neurosyphilis, due to increased risk of progressive central nervous system involvement. These cases highlight the challenges in diagnosing ocular syphilis and emphasize the need for greater awareness of its epidemiology, particularly in rural settings where resources may be limited, and the consecutive nature of these cases underscore the importance of diagnostic and therapeutic vigilance in areas with potentially rising syphilis rates.
CATASTROPHIC ATRIAL SEPTAL RUPTURE POST-MITRAL VALVE REPLACEMENT IN A PATIENT WITH PULMONARY HYPERTENSION Michael Chammany, Kamal Masri; Edward Via College of Osteopathic Medicine, Monroe, LA.
Introduction: Severe symptomatic mitral valve regurgitation often necessitates surgical intervention via mitral valve repair or replacement. However, the surgical approaches utilized to access the mitral valve can lead to complications, particularly in patients with comorbidities such as pulmonary hypertension. In this case report, we present a rare instance of atrial septal rupture due to elevated pulmonary artery pressures secondary to pulmonary hypertension. Case: A 59-year-old man with obstructive sleep apnea and congestive heart failure due to severe mitral regurgitation was admitted for mitral valve replacement. Transesophageal echocardiography
revealed flail mitral valve segments consistent with mitral regurgitation, along with mild aortic regurgitation. Based on these findings, the patient underwent aortic and mitral valve replacements. During entry into the left atrium, the atrial septal wall was inadvertently damaged but was promptly repaired prior to closure. Postoperatively, the patient developed hypotension alongside elevated pulmonary artery pressures. The following day, his mean pulmonary artery pressure rose from 50 mmHg to 80 mmHg, and a subsequent transthoracic echocardiogram revealed an atrial septal defect. The patient was urgently taken to the operating room, where he experienced an eight-minute period 77
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