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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.
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.
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