Meehan Kelly, Rodman Julie
Midwestern University, Arizona College of Optometry, Glendale, Arizona 85038, USA.
Optom Vis Sci. 2010 Oct;87(10):E790-6. doi: 10.1097/OPX.0b013e3181f361b0.
Syphilis is a condition caused by the spirochete Treponema pallidum (T. pallidum). Because of its ubiquitous nature, it has been coined as "the great masquerader." Syphilis can present with a wide array of clinical symptoms and manifestations, making it difficult to diagnose. The spectrum of visual system manifestations is broad and involves the anterior and posterior segments. We report a rare case of ocular perineuritis in an HIV-positive patient with neurosyphilis.
A 33-year-old HIV-positive white male presented with blurred vision and floaters of 2 weeks duration. He reported coinciding neurological symptoms including headaches, nausea, and extreme weight loss. He also manifested an erythematous rash on his scalp. Fundoscopy revealed bilateral disc edema.
Syphilitic ocular perineuritis is a condition that manifests with swollen optic discs in the absence of raised intracranial pressure or visual disturbance. This condition is due to inflammation of the optic nerve sheath and is often mistaken for papilledema or papillitis. Optic perineuritis is an infrequently reported complication of syphilitic disease. Early diagnosis of neurosyphilis and its complications is critical, because it is easily treated with penicillin when initiated early on.
梅毒是由梅毒螺旋体引起的一种疾病。因其具有普遍性，它被称为“伟大的伪装者”。梅毒可表现出各种各样的临床症状和体征，这使得其难以诊断。视觉系统表现的范围很广，涉及眼前段和后段。我们报告了一例患有神经梅毒的HIV阳性患者发生眼部视神经周围炎的罕见病例。
一名33岁的HIV阳性白人男性出现视力模糊和飞蚊症，持续2周。他报告同时出现包括头痛、恶心和极度体重减轻在内的神经系统症状。他的头皮上还出现了红斑皮疹。眼底镜检查显示双侧视盘水肿。
梅毒性眼部视神经周围炎是一种在没有颅内压升高或视觉障碍的情况下表现为视盘肿胀的疾病。这种情况是由于视神经鞘的炎症引起的，常被误诊为视乳头水肿或乳头炎。视神经周围炎是梅毒疾病中一种较少报道的并发症。神经梅毒及其并发症的早期诊断至关重要，因为早期开始使用青霉素很容易治疗。
