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Case Reports
. 2012 Feb 14;17(1):3.
doi: 10.1186/2047-783X-17-3.

An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report

Paolo Turchetti  1 , Fernanda Pacella, Elena Pacella, Concetta Mirisola, Ilaria Uccella
Affiliations
Case Reports

An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report

Paolo Turchetti et al. Eur J Med Res. .

Abstract

Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.

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Figures

Figure 1
Figure 1
Fundus appearance of the left eye at initial presentation.
Figure 2
Figure 2
The 30-2 program of the Humphrey Visual Field Analyzer that indicates a slight central sensitivity loss or a paracentral scotoma in the left eye (see also Figure 3).
Figure 3
Figure 3
The 30-2 program of the Humphrey Visual Field Analyzer that indicates a slight central sensitivity loss or a paracentral scotoma in the left eye (see also Figure 2).
Figure 4
Figure 4
Optical coherence tomography (OCT) scan of the left eye at initial presentation. There was some thickening of the retinal pigment epithelium (RPE) layer with the inflammation of the optic nerve head with edematous and blurred margins.
Figure 5
Figure 5
The visual evoked potentials (VEP) revealed a decrease in VEP amplitude with normal latency in the left eye.
Figure 6
Figure 6
(A) Fundus fluorescein angiogram at presentation of syphilitic papillitis. (B) Fundus fluorescein angiogram 4 weeks after treatment.
See this image and copyright information in PMC

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