UNILATERAL OPTIC NEURITIS AND CENTRAL RETINAL VASCULITIS DUE TO OCULAR SYPHILIS
- 1 January 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in RETINAL Cases & Brief Reports
- Vol. 14 (1), 35-38
- https://doi.org/10.1097/icb.0000000000000614
Abstract
Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis. A case report of a 22-year-old man with progressive unilateral vision loss. With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin. This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.Keywords
This publication has 7 references indexed in Scilit:
- British Ocular Syphilis Study (BOSS): 2-Year National Surveillance Study of Intraocular Inflammation Secondary to Ocular SyphilisInvestigative Ophthalmology & Visual Science, 2014
- A Complicated Case of SarcoidosisJAMA Ophthalmology, 2014
- The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type HypersensitivityThe American Journal of Dermatopathology, 2011
- Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosisTherapeutic Advances in Neurological Disorders, 2011
- Case 26-2010The New England Journal of Medicine, 2010
- Secondary Syphilitic LesionsClinical Microbiology Reviews, 2005
- Ischaemic papillopathy. Clinical and fluorescein aniographic review of forty cases.British Journal of Ophthalmology, 1974