Ocular Syphilis Masquerading the Arteritic Ischemic Optic Neuropathy: A Case Presentation

Abstract

Purpose: To report a case presenting with the clinical findings insinuating the arteritic ischemic anterior optic neuropathy who received the diagnosis of ocular syphilis.

Method: Case presentation.

Case Presentation: An 86-year-old woman presented with sudden painless vision loss in her only good right eye (OD). Her medical history was unremarkable except the left eye (OS) glaucoma. Her best corrected visual acuity (BCVA) was counting fingers at 1 meter in OD, hand motion in OS, and color vision was 0/21 bilaterally with the Ishihara pseudoisochromatic plates. Slit-lamp examination was unremarkable for both eyes. Right optic disc edema and peripapillary retinal hemorrhage was observed together with a left pale optic disc upon dilated fundoscopy. As the inflammatory blood markers were elevated, prompt pulse corticosteroid treatment (1000 mg/day) was commenced and intravitreal 4 mg triamcinolone acetonide injection was performed with the presumption of right arteritic ischemic optic neuropathy. At the third day of the treatment, serologic tests revealed the presence of syphilis. Pulse corticosteroid treatment was discontinued, and 2 gr/day intravenous ceftriaxone treatment was administered for 14 days. Cranial neuroimaging revealed the signal enhancement of the right optic nerve at the retrobulbar level. Even though the patient reported a subjective increase in her vision, her BCVA remained stable at the first month follow-up.

Conclusion: The present case emphasizes the importance of a high clinical suspicion for syphilis even in cases with optic neuropathy.