Syphilitic Optic Neuropathy: Re-emerging Cases Over a 2-Year Period

Apinyawasisuk, Supanut; Poonyathalang, Anuchit; Preechawat, Pisit; Vanikieti, Kavin

doi:10.3109/01658107.2015.1134586

Cited by 22 publications

(16 citation statements)

References 9 publications

(9 reference statements)

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“…Over an 8-year period at a tertiary medical centre during which 123 patients were hospitalized with newly diagnosed syphilis, one-quarter of all cases had ocular manifestations, and the most common presenting ocular finding was optic nerve involvement (78%), consisting of 25 eyes of 18 patients. Optic nerve manifestations were less common in other studies (Prokosch & Thanos 2008;Mathew et al 2014;Northey et al 2015;Apinyawasisuk et al 2016); while in the study by Fonollosa and colleagues (Fonollosa et al 2016), papillitis was the most common ocular manifestation, presenting in 31 eyes, representing a third of their patients.…”

Section: Discussionmentioning

confidence: 71%

“…; Apinyawasisuk et al. ); while in the study by Fonollosa and colleagues (Fonollosa et al. ), papillitis was the most common ocular manifestation, presenting in 31 eyes, representing a third of their patients.…”

Section: Discussionmentioning

confidence: 94%

“…; Prokosch & Thanos ; Apinyawasisuk et al. ). In our practice, systemic corticosteroids are added if the initial IV penicillin treatment is not followed by an improvement in ocular signs and/or in visual function.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Northey et al (2015) and Fonollosa et al (2016) found good visual prognosis in their series. Although there are no controlled studies proving the benefits of adjunctive systemic corticosteroid treatment, there are supportive data for its benefit in the literature (Smith et al 2006;Prokosch & Thanos 2008;Apinyawasisuk et al 2016). In our practice, systemic corticosteroids are added if the initial IV penicillin treatment is not followed by an improvement in ocular signs and/or in visual function.…”

Section: Discussionmentioning

confidence: 99%

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The great imitator on the rise: ocular and optic nerve manifestations in patients with newly diagnosed syphilis

Klein

Fischer

Goldstein

et al. 2018

Acta Ophthalmologica

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Purpose Ocular manifestations of syphilis have been reported in 2–10% of systemic infection. The purpose of this study was to report the incidence of ocular syphilis and various ocular manifestations, particularly optic nerve involvement, in newly diagnosed cases. Methods This was a retrospective study. Medical records of newly diagnosed syphilis patients between January 2009 and January 2017 in a tertiary medical centre were reviewed. Results There were 123 new systemic syphilis cases out of 569,222 (0.02%) admissions to the Tel Aviv Medical Center during the study period. Ninety‐three of the 123 patients (76%) underwent ophthalmological examination. Twenty‐three of the 93 patients (25%, mean age 48.6 ± 12.9 years, 20 males) had ocular syphilis, and in 12/23 (52%) patients, the ocular symptoms and findings prompted syphilis investigation. Eighteen of the 23 (78%) had optic nerve involvement, and the most common was inflammatory disc oedema. Older age (p = 0.0005) and tertiary stage disease (p = 0.0441) were associated with ocular manifestations and the presence of optic nerve findings. Human immunodeficiency virus (HIV) was associated with ocular but not optic nerve findings. Treatment included intravenous penicillin G, and four patients with severe optic neuropathy were also treated with systemic corticosteroids. Visual acuity significantly improved in most patients (p < 0.05). Conclusion Ocular syphilis was found in one‐quarter of the patients diagnosed with systemic syphilis and preceded the diagnosis of systemic disease in one‐half of them. Optic nerve involvement was a common manifestation. A high index of suspicion for Treponema infection is required in patients presenting with optic nerve involvement to facilitate prompt diagnosis and treatment. Post‐treatment visual outcome was good.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The great imitator on the rise: ocular and optic nerve manifestations in patients with newly diagnosed syphilis

Klein

Fischer

Goldstein

et al. 2018

Acta Ophthalmologica

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“…The overall increase in syphilis incidence has naturally led to an increased prevalence of ocular syphilitic involvement 11. Ocular involvement is reported to occur in less than 1% to 10% of all cases of syphilis,12–15 with the optic nerve involved in approximately 20% of cases of ocular syphilis 11. Syphilis was responsible for 2.27% of cases of optic neuritis in one study involving 132 patients 16.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis presenting as visually asymptomatic bilateral optic perineuritis

Yosar

2019

BMJ Case Rep

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A 39-year-old Caucasian man presented with headaches and retro-orbital pain but normal vision. Bilateral optic nerve swelling was found on funduscopy though optic nerve function and computed perimetry were normal and there was no relative afferent pupillary defect. CT venogram and MRI were unremarkable. Cerebrospinal fluid (CSF) opening pressure was normal on lumbar puncture and Treponema pallidum antibodies and T. pallidum particle agglutination test were positive on CSF analysis. He tested negative for HIV. Symptoms rapidly resolved with 2 weeks of intravenous benzylpenicillin. At 1 month follow-up, the right optic nerve swelling had reduced while the left optic nerve swelling had increased; his vision remained unaffected and he was symptom free and continued to have no objective evidence of optic nerve dysfunction.

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