Ocular Syphilis Unmasked Following Intravitreal Triamcinolone Injection

Purpose: To report intravitreal triamcinolone (IVTA)-induced unmasking of ocular syphilis. Design: Two case reports. Methods: A homosexual, diabetic male with macular edema treated with bilateral IVTA and a male with bilateral panuveitis and macular edema who underwent vitrectomy and IVTA. Both developed occlusive retinal vasculitis and panuveitis postinjection. Syphilis serology was positive although both denied previous symptoms. Results: Intramuscular penicillin lead to resolution of inflammation but both sustained severe loss of vision. Cause-and-effect relationship demonstrated between IVTA and reactivation of syphilis. Conclusions: Intravitreal corticosteroid can modulate the immune response to intraocular syphilis; vigilance is required, particularly in high-risk patients.