Author: María del Mar Prieto del Cura (Spain)
Co-authors: Pilar Criado Muñoz, María José Crespo Carballés, Icíar Irache Varona, Simon Quijada Angeli, José García Hinojosa
Syphilis can display diverse ophthalmologic manifestations. The purpose of this report is to present a case of optic and vestibulocochlear neuropathy as a manifestation of syphilis. This is a case report of a 41-year-old man who complained of blurry central vision in right eye (RE) and hearing loss in his right ear over the past 2 weeks.
Hospital Universitario Infanta Leonor. Av. Gran Via del Este, 80, 28031 Madrid, Spain.
The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination, autofluorescence images, fluorescein angiography, Goldmann visual fields, spectral-domain optical coherence tomography (OCT). Audiometry and laboratory tests were also assessed.
A 41-year-old man complained of blurry central vision in his RE, hearing loss in his right ear and recent fatigue over the past 2 weeks. Measles caused profound hearing loss in his left ear in his childhood. Visual acuity (VA) was 20/80 in RE and 20/25 in left eye. The anterior segment, the tonometry and the pupillary reflexes were normal. Fundoscopy revealed swelling of the right optic disc with pigmentary retinopathy in both eyes. Fundus Autofluorescence (FAF) evidenced a mottled pattern of hyperautofluorescence. Optical coherence confirmed edema in the right optic disc, and fluorescein angiography revealed progressive hyperfluorescence, with perivascular (vasculitis) and disc (papillitis) leakage in the late frames of the RE. The results of the rapid plasma reagin (RPR) test were positive for syphilis and cerebrospinal fluid. Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. No abnormalities were detected during magnetic resonance imaging of the brain. Audiometry revealed impaired sound transmission both through the air and bone in both ears, with greater effects observed for the higher frequencies in the right ear so diagnosis of sensorineural deafness was made. Treatment (intravenous and intramuscular penicillin for 3 weeks was able to resolve the visual and hearing disturbances.
This report describes an infrequent case of unilateral optic neuropathy and ipsilateral. Due to the wide variety of clinical forms it can manifest, syphilis has been referred to as ‘the great pretender or simulator’ and should be ruled out in all patients with ocular inflammation. Optic nerve involvement in syphilis may be unilateral or bilateral and becomes apparent as perineuritis, anterior or retrobulbar optic neuritis or papilloedema.