Incipient Syphilitic Papillitis.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neuro-Ophthalmology

Background:

• Syphilis can manifest with optic disc edema (ODE), often attributed to increased intracranial pressure or optic perineuritis.
• Previous understanding linked ODE in syphilis to papilledema or optic nerve sheath inflammation.

Purpose of the Study:

• To describe a distinct presentation of ocular syphilis characterized by optic disc edema with preserved visual function.
• To propose a new term, "incipient syphilitic papillitis," for this specific clinical scenario.

Main Methods:

• Retrospective case series of four patients with syphilis presenting with optic disc edema.
• Clinical examination, visual function tests, lumbar puncture for intracranial pressure measurement, and magnetic resonance imaging (MRI) of the optic nerves and orbits were performed.

Main Results:

• Four patients with syphilis exhibited optic disc edema but maintained normal visual acuity and color vision.
• Intracranial pressure was normal in all cases, and MRI revealed no enhancement of the optic nerve or its sheath.
• This presentation differs from typical syphilitic optic perineuritis.

Conclusions:

• Optic disc edema in syphilis can occur without visual compromise, elevated intracranial pressure, or optic nerve sheath enhancement.
• The term "incipient syphilitic papillitis" is proposed for this presentation, suggesting it may be more common than syphilitic optic perineuritis.