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Incipient Syphilitic Papillitis.

John J Chen1,2, M Tariq Bhatti1,2, Elizabeth Bradley1

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Syphilis can cause optic disc edema (ODE) without vision loss. Researchers propose "incipient syphilitic papillitis" for this presentation, differentiating it from optic perineuritis.

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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.