Multimodal Imaging of Iris Roseola/Papulosa: An Unusual Manifestation of Syphilitic Uveitis.

PURPOSE: To characterize on multimodal imaging a case of iris roseola/papulosa, a unique manifestation syphilitic uveitis. METHODS: Retrospective review of clinical data, laboratorial results and multimodal imaging (MI). RESULTS: A 52-year-old white woman presented with decreased vision, redness and pain in the right eye (OD) for four days, preceded by a cutaneous rash two weeks before. Clinical evaluation revealed anterior uveitis in OD, associated with a vascularized deep nodule in the superotemporal aspect of the right iris, consistent with iris roseola and iris papulosa. MI disclosed progressive hyperautofluorescence of the iris deep stromal nodule, associated with detachment of iris pigment epithelium in OD, as well as unsuspected hyperfluorescence of the retinal veins and optic nerve head in the left eye (OS). Results of VDRL (1:128) and treponemal tests confirmed syphilis, with negative anti-HIV result. Treatment with aqueous crystalline penicillin G was initiated for 21 days, and supplemented with oral prednisone 24 h later, after development of a Jarisch-Herxheimer reaction. Prompt and complete resolution of the iris lesion and remission of intraocular inflammation were achieved after antibiotic therapy. CONCLUSION: Vascularized iris lesions are currently rare but possibly underestimated manifestations of secondary syphilis. Multimodal imaging may be of help for better characterization of their vascular component, as well as for delineating other subtle inflammatory changes that may go unnoticed. Antibiotic treatment supplemented with steroids is curative in the short term.