A 49-year-old otherwise healthy Chinese immigrant presented with a chief complaint of decreased vision in both eyes of several years' duration. The patient reported that at age 20 years she "went blind" in both eyes and was unable to see for several months. Following the use of Chinese herbal medicine topically and penicillin shots intramuscularly, she partially regained her vision.
Examination revealed highly arborized interstitial corneal vessels associated with deep stromal scarring that caused corneal opacity (Figs 1 and 2). Numerous red blood cells were seen by retroillumination.
Laboratory results were negative for the rapid plasma reagin test and positive for microhemagglutination assay Treponema pallidum (MHA-TP, a specific antibody test), which were compatible with treated syphilis.
Interstitial keratitis is an increasingly uncommon condition that is a manifestation of prenatal syphilis.1 It is thought to be the result of an immunologic phenomenon directed against treponemal antigens deposited in the cornea.
Lee ME, Lindquist TD. Syphilitic Interstitial Keratitis. JAMA. 1989;262(20):2921. doi:10.1001/jama.1989.03430200169047