Franco Monica*, Colaço Luisa, Pereira Cristina, Neves Joana and Seldon Raquel
Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
Received: June 10, 2014; Accepted: July 24, 2014; Published: July 26, 2014
Franco Monica, Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal, Email: email@example.com
Monica F, Luisa C, Cristina P, Joana N, Raquel S (2014) Secondary Syphilis Presenting as Optic Neuritis in an Immunocompetent Patient: Case Report. J Clin Res Ophthalmol 1(1): 019-021. DOI: 10.17352/2455-1414.000005
© 2014 Monica F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Syphilis; Optic neuropathy; Immunocompetent; Penicillin
Purpose: The purpose of this report is to present a case of optic neuropathy as a manifestation of secondary syphilis in an HIV-negative patient.
Methods: We describe a case of gradual loss of visual acuity in the left eye (LE) in a 53-year-old healthy woman.
Results: The patient presented with visual acuity of 20/20 in the right eye and hand movements in the LE. Fundoscopy revealed swollen optic disc in the LE. Fluorescein angiography showed leakage of dye from the optic disc. Optical coherence tomography (OCT) confirmed the oedema in the left optic disc. Serologic testing was positive for venereal disease research laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS), and negative for HIV antibodies.
Conclusions: Ophthalmologic findings, including disc oedema, may be the presenting features of syphilis, therefore ophthalmologists have the opportunity to play a key role in the diagnosis and management of this disease, important for a good visual outcome.
Syphilis is a sexually transmitted, systemic infection caused by the spirochete bacterium Treponema pallidum . The incidence of syphilis continues to rise in the USA and Europe, and it is estimated that around 20% of patients with syphilis in the USA also have HIV infection[2-4]. Ocular involvement may be silent or present as anterior uveitis, choroiditis, interstitial keratitis, retinal vasculitis, retinitis, optic neuritis, dacryoadenitis, or scleritis [5-7]. The observation of optic nerve abnormalities in an ophthalmological examination in a patient with syphilis is highly suggestive of central nervous system (CNS) involvement and should be considered synonymous with neurosyphilis [8,9].
The purpose of this report is to present a case of optic neuropathy as a manifestation of secondary syphilis in an HIV-negative patient.
The authors obtained written consent from the patient for the publication of her anonymised clinical data.
A 53-year-old healthy woman presented with complaints of decreased visual acuity in the left eye (LE) which she had begun to notice 2 weeks prior. In a general examination, a rash on the palms and soles was detected. Best corrected visual acuity of 20/20 in the right eye (RE) and hand movements in the LE. Biomicroscopy of the anterior segment was unremarkable in both eyes, and intra-ocular pressure was 12mmhg in both eyes. Fundoscopy showed a swollen optic disc in the LE, with no abnormalities detected in the RE. A left relative afferent pupillary defect was present (Figure 1 and Figure 2).