1. Hypopyon Uveitis Linda Huang, MD Ronald Rescigno, MD Rutgers, New Jersey Medical School

2. Ocular History  58 year old man  OS: Pain, redness, decreased vision for one week  Denies past medical and ocular history

3. First Presentation  VA: OD 20/20, OS CF  OS: +2 conjunctival injection +4 AC cell, hypopyon, posterior synechiae +3 anterior vitreous cell  Fundus: OD within normal OS no view  B scan OS: Vitritis, flat retina, normal choroid

6. First Presentation  Patient sent for:  CBC  Chemistry  ACE  RPR/VDRL  Blood Cultures  PPD  Chest X ray

7. Follow up after a few weeks  He did not get any testing done  He went to another clinic and was diagnosed with VKH and started on Prednisone.  Taking Prednisone 40mg PO daily

8. Follow up  Now complaining of decreased vision OD  VA: OD CF, OS HM  OS: remains unchanged  OD:  Retinitis involving the posterior pole  Retinal arteritis  Retinal precipitates  Pseudohyopyon

11. Follow up  Initial Workup reordered  Serum VDRL 1:4096 FTA+  CSF VDRL +  HIV+ CD4 1,253 cells/mm

12. Treatment  IV penicillin G 4 million units every 4 hours for two weeks

13. Follow up 3 weeks after treatment  VA OD 20/20, OS CF  Fundus exam OD returned to baseline

15. Final Diagnosis  Neurosyphilis with bilateral panuveitis  in an HIV positive patient

16. Conclusion  Clinical manifestations of syphilis are highly variable  Can mimic many other ocular disorders  Often leads to misdiagnosis and delay in treatment  High rates of concurrent HIV infections  Important to consider in your differential diagnosis of hypopyon