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Retrobulbar neuritis complicating acute Epstein-Barr virus infection
M D Anderson1, C A Kennedy, A W Lewis
1Department of Internal Medicine (Infectious Diseases), Naval Medical Center, San Diego, California.
Summary
A false-positive syphilis test (MHA-TP) can occur with Epstein-Barr virus (EBV) infection, mimicking neurosyphilis. This case highlights EBV as a cause of retrobulbar neuritis and MHA-TP false positives.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neurology
Background:
- Retrobulbar neuritis is optic nerve inflammation often associated with demyelinating diseases.
- Syphilis testing involves assays like the microhemagglutination assay for Treponema pallidum (MHA-TP) and Venereal Disease Research Laboratory (VDRL) assay.
- Epstein-Barr virus (EBV) is a common human herpesvirus with diverse clinical manifestations.
Observation:
- A 19-year-old male presented with retrobulbar neuritis.
- Initial syphilis testing revealed a positive MHA-TP but a negative VDRL.
- Subsequent testing confirmed Epstein-Barr virus (EBV) infection via heterophile antibody assay and serology.
Findings:
- The patient's presentation mimicked neurosyphilis due to a positive MHA-TP.
- The negative VDRL and positive EBV serology indicated a biological false-positive MHA-TP.
- Retrobulbar neuritis was attributed to Epstein-Barr virus infection.
Implications:
- Physicians should consider Epstein-Barr virus infection in patients presenting with retrobulbar neuritis and a positive MHA-TP.
- Awareness of biological false-positive MHA-TP results in EBV infection is crucial for accurate diagnosis and management.
- This case underscores the importance of comprehensive diagnostic workups to differentiate infectious etiologies.