Syphilitic bilateral neuroretinitis--a case report

Syphilis is a sexually transmitted, chronic, systemic infection of increasing prevalence. Ocular symptoms may develop at any stage of the disease process. This is to present a case of acute severe bilateral visual loss due to neuroretinitis with papillar oedema in an immunocompetent 37 years old patient.

Indirect ophtalmoscopy showed symmetrical papillar oedema in both eyes and macular oedema in the right eye. Fundus fluorescein angiogram was performed revealing neuroretinitis in both eyes. Syphilis specific serological test results were positive. The patient was treated with intramuscular injections of penicillin 2.4 mln U per day for 5 days followed by 1.2 mln U per day for total 26 days.

His visual acuity improved to 1.0 in both eyes during 6 months follow up period. All pathological changes withdrew.

This case shows that patients with unexplained visual loss coexisting with neuroretinitis should be tested for syphilis. With proper antibiotic treatment recovery of visual acuity may be observed.