Infect Chemother.  2010 Aug;42(4):262-265. 10.3947/ic.2010.42.4.262.

A Case of Neurosyphilis with Acute Optic Neuritis and Trochlear Nerve Palsy in Human Immunodeficiency Virus Infected Male

• Kim J
• Jung H
• Kim B
• Song Y
• Ko M
• Pai H

• KMID: 1457390
• DOI: http://doi.org/10.3947/ic.2010.42.4.262

Abstract

With the increase in human immunodeficiency virus (HIV) infection, the incidence of syphilis also increased worldwide presenting with diverse clinical manifestations. We experienced a case of symptomatic early neurosyphilis manifesting as optic neuritis and trochlear nerve palsy with typical skin lesions of secondary syphilis in an HIV-Infected patient. Intravenous penicillin and oral steroid were administered for 2 weeks. Skin lesions improved after a week, and ocular lesions resolved completely after eight weeks of treatment.

Keyword

Neurosyphilis; Optic neuritis; Trochlear nerve palsy; Human immunodeficiency virus (HIV)

MeSH Terms

HIV
Humans
Incidence
Male
Neurosyphilis
Optic Neuritis
Penicillins
Skin
Syphilis
Trochlear Nerve
Trochlear Nerve Diseases
Penicillins
Syphilis

Figure

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  Figure 1 The patient has multiple erythematous scaly annular plaques on the scrotum (A), palm (B), and sole (C).

• 

  Figure 2 At the time of diagnosis, right eye demonstrates severe papillary edema with surrounding neuroretinal edema. The retinal vein is slightly dilated. Hyperemic appearance and peripapillary splinter hemorrhage suggest an acute condition.

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  Figure 3 After 3 days of treatment, there is no improvement in the right eye.

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  Figure 4 Two weeks after the treatment with penicillin and steroid, right papillary edema has improved and peripapillary retinal vasculature returns to normal. However, mild disc hyperemia is still seen.

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  Figure 5 Eight weeks after the treatment, right eye shows sharp disc margin and normal pinkish color.

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