Syphilis presenting with headache and papilloedema.

A 41-year-old homosexual man presented with a 10-week history of headache without pressure features commencing 10 weeks after a new sexual contact. Three days after the headache onset he noticed intermittent, bilateral visual blurring, worse in the right eye. The visual disturbance persisted intermittently and led to his referral to a local ophthalmology department where he was found to have bilateral papilloedema. There were no other abnormal signs on full examination of other systems and no other abnormal ocular findings. Cerebral imaging studies were normal. A lumbar puncture revealed a raised opening pressure of 35 mm cerebrospinal fluid (CSF) with a white cell count of 58 cells/mcl (mainly lymphocytes). Venereal disease research laboratory (VDRL), Treponema pallidum haemagglutination (TPHA) and Inno-LIA tests confirmed the presence of neurosyphilis. HIV testing was negative. He was treated with CSF pressure reduction via repeat lumbar puncture and acetozolamide and procaine penicillin intramuscularly. He recovered and remains symptom free at 1 year.