A case of secondary syphilis presenting as optic neuritis

• Published in: Neurological sciences Vol. 31; no. 3; pp. 365 - 367
• Main Authors: Bandettini di Poggio, Monica, Primavera, Alberto, Capello, Elisabetta, Bandini, Fabio, Mazzarello, Giovanni, Viscoli, Claudio, Schenone, Angelo
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.06.2010; Springer Nature B.V
• Subjects: Anti-Bacterial Agents - therapeutic use; Case Report; Diagnosis, Differential; Disease Progression; Homosexuality, Male; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Neurosyphilis - diagnosis; Neurosyphilis - drug therapy; Neurosyphilis - pathology; Optic Disk - pathology; Optic Neuritis - diagnosis; Optic Neuritis - pathology; Penicillin G - therapeutic use; Psychiatry; Time Factors; Treatment Outcome; Treponema pallidum; Ocular manifestation; Meningitis; Neurosyphilis; Syphilis; Optic neuritis
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-010-0222-8

Neurosyphilis is still a significant medical problem in developing countries and syphilitic ocular manifestations are often not diagnosed due to the lack of typical characteristics. We describe the case of a 59-year-old homosexual man with a 1-month history of decreased vision acuity in his left eye who was diagnosed with neurosyphilis and received treatment with intravenous penicillin G (16 million units in divided daily doses), with great improvement of visual acuity and CSF examination findings. The interest of this case is not only represented by the unusually early ocular involvement, but also by the rapid evolution of the disease into the secondary stage in a man who had had one at-risk homosexual relationship only 3 months before the onset symptoms. We also support the view that the presence of ocular involvement in syphilitic patients is suggestive of involvement of the CNS and should be considered synonymous with neurosyphilis.