Syphilitic Optic Neuropathy
A 40-year-old male complained of blurred vision in the right eye for 6 days. The patient had congenital heart disease and underwent a cardiac operation at age 14. His past medical history also included nephritis with subsequent nephrectomy at age 19. In his 20s, he was treated for a sexually transmitted disease. His best-corrected visual acuity was 6/15 in the right eye and 6/5 in the left. He could identify only 6 plates in the right eye and 14 plates in the left with the Ishihara color test. The anterior segment was normal for both eyes. Ophthalmoscopic examination revealed bilateral disc swelling with hyperemic change (Fig. 4.1). Central scotoma was noted in both eyes (Fig. 4.2). There was no enhancing lesion found along the optic nerve (Fig. 4.3). Blood tests showed normal white blood cell counts with a mildly depressed lymphocyte percentage (16%) and an increased eosinophil percentage (6.6%). CSF study was unremarkable. Inflammatory indices such as ESR and CRP were both elevated. Syphilitic tests were all positive, with serum VDRL 1:16 (+), TPHA 1:2560 (+), and FTA-ABS (4+) reactive. The patient received intravenous aqueous PCN treatment, and his vision improved to 6/8.6 in the right eye.
- 9.Walsh FB, Hoyt WF. Infections and parasitic invasions of the nervous system. In: Clinical neuro-ophthalmology, vol. 2. 3rd ed. Baltimore: Williams and Wilkins; 1969. p. 1581–91.Google Scholar