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Optic Nerve Manifestation in a Patient with Neurosyphilis
Hasche H., Grehn F.,
Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)
Purpose: A significant increase in reported syphilis cases in large cities and urban areas particularly among high-risk groups has been recognized. Syphilis increases the risk of HIV infection. Early diagnosis and treatment of syphilis is an important factor in the prevention of AIDS.
Patient: A 40-year old male patient presented with blurred vision in the right eye for a few days. Additionally he reported having chronic haedache. The neurological examination was unremarkable. Best corrected visual acuity was 0.8. The fundus examination of the right eye showed a prominent optic disc with indistinct margins and with enlargement of the blind spot in the visual field. The cranial computed tomografic scan was normal. Serologic studies disclosed a reactive FTA-ABS test and showed a positive syphilis-immunoblot IgM-antibody result. Other serologic results and cultures were negative. The cerebrospinal fluid contained 57 cells/µl and a reactive FTA-ABS test. There was no sign of local cerebral antibody production. The patient was treated with intravenous penicillin for 14 days. The visual acuity impoved to 1.25 and the papillitis resolved completely within 7 weeks.
Conclusions: Syphilitic ocular inflammation in secondary stage of the disease includes a variety of manifestations. Due to an increasing incidence all patients with unexplained ocular inflammation should undergo a routine FTA-ABS and VDRL screening.