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Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition

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Unilateral swollen optic disc: do not forget neurosyphilis.

Lénea Porto¹, Joana Capelo, Adelino Carragoso

¹Department of Internal Medicine 1, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. leneaporto@gmail.com

BMJ Case Reports

|July 12, 2013

Summary

Neurosyphilis can cause vision loss. This case highlights a 51-year-old man with progressive vision loss due to neurosyphilis, successfully treated with penicillin, leading to vision recovery.

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Area of Science:

Ophthalmology
Neurology
Infectious Diseases

Background:

Neurosyphilis is a rare complication of syphilis infection that can affect the central nervous system.
Ocular manifestations of neurosyphilis can be diverse and may mimic other optic neuropathies.

Observation:

A 51-year-old man presented with a 3-month history of progressive right visual loss.
Examination revealed decreased visual acuity and a swollen optic disc.
Previous investigations, including MRI, were normal, and corticosteroid treatment was ineffective.

Findings:

Blood tests revealed a positive rapid plasmatic reagin test (1:64) and elevated antibodies against Treponema pallidum (ELISA).
Cerebrospinal fluid analysis showed mild leucocytosis and elevated protein content.
These findings confirmed neurosyphilis as the cause of optic disc swelling and visual loss.

Implications:

Early diagnosis and treatment of neurosyphilis are crucial for visual recovery.
Penicillin therapy led to significant improvement in visual acuity and resolution of optic disc swelling.
This case underscores the importance of considering syphilis in the differential diagnosis of optic neuropathies, even with normal initial MRI findings.