J Korean Ophthalmol Soc.  2014 Jul;55(7):1115-1120.

A Case of Ocular Syphilis Presenting as Bilateral Optic Neuritis

• Lee HJ
• Kim MJ
• Cha DM
• Lee SH
• Jeong JH

Abstract

PURPOSE
To report a case of ocular syphilis presenting as bilateral optic neuritis.
CASE SUMMARY
A 25-year-old man presented with visual difficulty in both eyes that had begun 2 weeks previously. Best corrected visual acuity was 0.7 in the right eye and 0.1 in the left eye. Anterior segment was normal. On fundoscopic examination, optic disc swelling was found in both eyes. Color vision was abnormal in the left eye. The visual field (VF) showed peripheral constriction in the right eye and generalized reduction in the left eye. Fluorescein angiography revealed early, bilateral leakage of dye from the optic disc with multiple hot spots in the chorioretinal level. Serology was positive for fluorescent treponemal antibody absorbance (FTA-ABS) IgM, IgG and rapid plasma reagin test. A test of the cerebrospinal fluid was positive for venereal diseases research laboratory and FTA-ABS IgG. A diagnosis of syphilitic optic neuritis was made and the patient was treated with antibiotics. Six months later, visual acuity was 1.0 in the right eye and 0.8 in the left eye. There was no disc swelling on both fundoscopy and optical coherence tomographs. VF also improved after treatment, with the restoration of central vision.
CONCLUSIONS
Syphilis can present as optic neuritis. Clinicians should consider serologic examination for syphilis and then initiate appropriate antibiotic treatment.

Keyword

Infectious optic neuritis; Neurosyphilis; Ocular syphilis; Papillitis; Treponema pallidum

MeSH Terms

Adult
Anti-Bacterial Agents
Cerebrospinal Fluid
Color Vision
Constriction
Diagnosis
Fluorescein Angiography
Humans
Immunoglobulin G
Immunoglobulin M
Neurosyphilis
Optic Neuritis*
Papilledema
Plasma
Sexually Transmitted Diseases
Syphilis*
Treponema pallidum
Visual Acuity
Visual Fields
Anti-Bacterial Agents
Immunoglobulin G
Immunoglobulin M

Figure

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  Figure 1. Fundus photographs showing mild optic disc swelling, disappearance of physiologic cupping and multiple chorioretinal lesions (arrows) in the left eye, and relatively normal optic disc and retina in the right eye.

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  Figure 2. Fluorescein angiographs showing early leaking from the left optic disc (A), staining along the superotemporal retinal vein with adjacent chorioretinal leaking (B, C) and minimal leaking in the right eye (D).

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  Figure 3. Visual fields (VF) showing generalized reduction in the left eye (A) and peripheral constriction in the right eye (B) at the initial presentation.

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  Figure 4. Optical coherence tomographs (OCT) showing mild optic disc swelling in both eyes. TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; T = temporal; N = nasal; I = inferior; RNFL = retinal nerve fiber layer.

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  Figure 5. Fundus photographs showing normal optic disc after 6 months of treatment.

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  Figure 6. Visual fields (VF) showing peripheral constriction sparing central VF in both eyes (A: left eye, B: right eye) after 6 months.

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  Figure 7. Optical coherence tomographs (OCT) showing normalized peripapillary retinal nerve fiber layer thickness after 6 months of treatment. TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; S = superior; T = temporal; N = nasal; I = inferior; RNFL = retinal nerve fiber layer.

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