[Bilateral papillary edema in cerebrospinal syphilis]

Nowadays luetic infections are rarely seen by ophthalmologists. We report on an immunocompetent ophthalmologically asymptomatic patient with bilateral papilledema due to perineuritis optici in lues cerebrospinalis.

A 47-year old female patient presented with presbyopic complaints. Additionally she reported occasional dizziness with nausea and hearing loss with tinnitus. Visual acuity measured 16/20. There was a bilateral prominent optic disc with indistinct margins and papillary hemorrhagies on the right side and corresponding enlargement of the blind spot in the visual field. Echography revealed bilateral optic drusen. Serological examination suggested lues (TPHA 1:5120, IgM-FTA-Abs-Test 1:320, Cardiolipin 1:640). Cerebrospinal fluid examination indicated an inflammatory process in the CNS without proof of an autochthonous antibody production.

Even nowadays lues cerebrospinalis must be suspected in patients with bilateral papilledema without visual loss. The ophthalmologist holds an important diagnostic position, because adequate treatment is able to prevent disease progression.