Neurosyphilis with associated retinitis

A 59-year-old black male presented with an acute unilateral central scotoma and decreased visual acuity in each eye. Ocular examination revealed bilateral vitritis, nerve fiber layer hemorrhages and infarcts, arteritis, serous macular edema and optic nerve head edema with telangiectasia. Vascular work-up was remarkable for a reactive FTA-ABS, VDRL and RPR. Lymphocytes, monocytes, basophils and platelet count were elevated. HIV tests were nonreactive. Ocular, serologic and cerebrospinal fluid findings along with past sexual history were consistent with a diagnosis of early neurosyphilis. Prompt referral to an infectious disease physician and subsequent treatment with parenteral penicillin resulted in complete resolution of the vitreoretinitis.