Khan Murtaza S, Kuruppu Dulanji K, Popli Tanav A, Moorthy Ramana S, Mackay Devin D
Department of Neurology, Indiana University, Indianapolis, Indiana.
Indiana University School of Medicine, Indianapolis, Indiana; and.
Retin Cases Brief Rep. 2020 Winter;14(1):35-38. doi: 10.1097/ICB.0000000000000614.
Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis.
A case report of a 22-year-old man with progressive unilateral vision loss.
With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin.
This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.
报告一例以单侧视神经炎和视网膜中央动脉阻塞同时出现为梅毒首发症状的病例。
对一名22岁进行性单侧视力丧失男性患者的病例报告。
该患者既往无梅毒、生殖器病变或其他眼外表现史，出现眼球运动时疼痛及色觉减退。口服类固醇治疗一个疗程后，其视力显著恶化。检查发现右眼视盘严重水肿，黄斑区樱桃红斑，轻度后葡萄膜炎。眼眶磁共振成像增强扫描显示右侧视神经远端强化增粗。荧光素血管造影显示右眼视网膜中央动脉充盈延迟，提示即将发生视网膜中央动脉阻塞。血清梅毒血清学检查呈阳性，脑脊液性病研究实验室试验呈反应性，符合神经梅毒。停用口服类固醇，静脉注射青霉素2周后视力改善。
该罕见病例突出了梅毒可能的首发表现之一：单侧视神经炎和伴有轻度后葡萄膜炎的视网膜中央动脉血管炎。在不明视力丧失病因的情况下，口服类固醇后视力恶化也凸显了口服类固醇使用的潜在并发症。全面的病史询问和检查可能有助于识别包括梅毒在内的感染性病因的危险因素，并应促使进行进一步评估。
