Neurosyphilis Presenting as Asymptomatic Optic Perineuritis

Introduction. Syphilis is a sexually transmitted disease that is known as “the great imitator” due to its wide variety of clinical presentations, including ocular disorders. There has been an increase in the rate of syphilis in the United States, especially in persons with HIV. We report a case of o...

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Main Authors: Sarah E. Parker, John H. Pula
Format: Article
Language:English
Published: Wiley 2012-01-01
Series:Case Reports in Ophthalmological Medicine
Online Access:http://dx.doi.org/10.1155/2012/621872
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author Sarah E. Parker
John H. Pula
author_facet Sarah E. Parker
John H. Pula
author_sort Sarah E. Parker
collection DOAJ
description Introduction. Syphilis is a sexually transmitted disease that is known as “the great imitator” due to its wide variety of clinical presentations, including ocular disorders. There has been an increase in the rate of syphilis in the United States, especially in persons with HIV. We report a case of optic perineuritis in an asymptomatic male secondary to central nervous system (CNS) syphilis. Case Report. A 41-year-old man was found to have bilateral disc edema on a routine exam. Brain MRI was unremarkable, and lumbar puncture revealed a normal opening pressure, with an elevated cerebrospinal fluid white cell count. Orbit MRI showed optic nerve sheath expansion and enhancement, consistent with optic perineuritis. He tested positive for syphilis based on serum RPR and FTA-ABS. Conclusion. Ophthalmologic findings, including disc edema, may be the presenting features of CNS syphilis. Even in asymptomatic persons, perineuritis should be considered early, as diagnosis and treatment are imperative given the progressive nature of the disease.
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spelling doaj-art-d9b2c53be5ae48bbbd04d6de839304f42025-02-03T01:31:38ZengWileyCase Reports in Ophthalmological Medicine2090-67222090-67302012-01-01201210.1155/2012/621872621872Neurosyphilis Presenting as Asymptomatic Optic PerineuritisSarah E. Parker0John H. Pula1Neuro-ophthalmology Unit, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, Peoria, IL 61611, USANeuro-ophthalmology Unit, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, Peoria, IL 61611, USAIntroduction. Syphilis is a sexually transmitted disease that is known as “the great imitator” due to its wide variety of clinical presentations, including ocular disorders. There has been an increase in the rate of syphilis in the United States, especially in persons with HIV. We report a case of optic perineuritis in an asymptomatic male secondary to central nervous system (CNS) syphilis. Case Report. A 41-year-old man was found to have bilateral disc edema on a routine exam. Brain MRI was unremarkable, and lumbar puncture revealed a normal opening pressure, with an elevated cerebrospinal fluid white cell count. Orbit MRI showed optic nerve sheath expansion and enhancement, consistent with optic perineuritis. He tested positive for syphilis based on serum RPR and FTA-ABS. Conclusion. Ophthalmologic findings, including disc edema, may be the presenting features of CNS syphilis. Even in asymptomatic persons, perineuritis should be considered early, as diagnosis and treatment are imperative given the progressive nature of the disease.http://dx.doi.org/10.1155/2012/621872
spellingShingle Sarah E. Parker
John H. Pula
Neurosyphilis Presenting as Asymptomatic Optic Perineuritis
Case Reports in Ophthalmological Medicine
title Neurosyphilis Presenting as Asymptomatic Optic Perineuritis
title_full Neurosyphilis Presenting as Asymptomatic Optic Perineuritis
title_fullStr Neurosyphilis Presenting as Asymptomatic Optic Perineuritis
title_full_unstemmed Neurosyphilis Presenting as Asymptomatic Optic Perineuritis
title_short Neurosyphilis Presenting as Asymptomatic Optic Perineuritis
title_sort neurosyphilis presenting as asymptomatic optic perineuritis
url http://dx.doi.org/10.1155/2012/621872
work_keys_str_mv AT saraheparker neurosyphilispresentingasasymptomaticopticperineuritis
AT johnhpula neurosyphilispresentingasasymptomaticopticperineuritis