Bilateral optic neuritis as initial manifestation of neurosyphilis in a HIV-positive patient

Syphilis, a disease which used to be terminal up to the 1950s, has become curable with the discovery of penicillin. In the last few years, an increase in its incidence has been recorded in the world as well as in Croatia, primarily with the human immunodeficiency virus (HIV) co-infection. We present a 40-year-old male patient who complained of a sudden decrease of visual acuity on both eyes, accompanied by dizziness. Clinical examination revealed low visual acuity and blurred edges of the optical nerve head without prominence. Pulse corticosteroid therapy failed to produce any recovery of visual acuity. Additional tests were done including Treponemapallidum hemagglutination assay (TPHA), which confirmed the infection with Treponema pallidum. The patient was administered Extencillin therapy. As a reaction to therapy administered, the patient's visual acuity gradually fully recovered. In the medical literature available, there is no report of optical neuritis as the first and only manifestation of HIV and syphilis coinfection.