Bilateral papillitis secondary to Neurosyphilis in an immunocompetent patient - Case report

Abstract

Context: Syphilis is a pleomorphic, insidious disease and an important differential diagnosis of ocular and CNS involvement. Its recognition and treatment are extremely important, given the high morbidity of its natural history. Case report: A 79-years-old woman started bilateral, intermittent and progressive visual turbidity, evolving in 5 months with pain on eye movement and intense throbbing bilateral headache, worse on the right, plus photophobia, and poor painkillers response. After 3 months, she presented fleeting amaurosis and was admitted to our service. On examination: severe low visual acuity, relative afferent pupillary defect, red desaturation and papilla edema. In CSF: hyperproteinorrachia and negative VDRL. Prednisone 60mg/day was started due to papillitis. Blood analysis showed 1/8 reagent VDRL, with other serologies, tumor and rheumatology markers negatives. She received crystalline Penicillin for 14 days, obtaining remission of headache, papilla edema and improved visual acuity. After 12 days, the visual acuity worsened, so Penicillin was extended to 21 days with 7g of methylprednisolone. After 3 days, the patient recovers the visual acuity she had before. Conclusions: The present study describes neuro-ophthalmological manifestation of syphilis in an immunocompetent individual. Although there is still controversy in the literature, in this case, high dose short-term corticoids was chosen, due to the severity of the loss of visual acuity, obtaining a favorable therapeutic response.