Syphiloma/gumma of the optic nerve and human immunodeficiency virus seropositivity

A 68-year-old man developed the sudden onset of transient obscurations of vision in the right eye in November 1988. Two weeks later he noted floaters, photophobia, and blurred vision in the left eye. He presented with unilateral optic disc edema in the right eye. The left eye showed anterior uveitis but a normal optic disc. He was found to be violently seroreactive for Treponema pallidum infection and was also human immunodeficiency virus (HIV) seropositive. Ultrasonography confirmed the presence of a solid thickening of the anterior optic nerve sheath in the right eye. An interesting and dramatic response to penicillin therapy occurred. This is the first instance of a gumma or solid syphiloma of the optic nerve documented by ophthalmic ultrasonography.