Tidsskr Nor Laegeforen. 2021 Jan 11;141(1). doi: 10.4045/tidsskr.20.0707. Print 2021 Jan 12.
Neurosyphilis is a rare cause of vision loss that can mimic the presentation of other diseases, including giant cell arteritis.
A man in his sixties presented to the university hospital with a four-day history of right eye vision loss. He experienced a headache, myalgia and fatigue. Right eye vision was limited to finger counting at 2 metres and a relative afferent pupillary defect was present. He was tender over the right temporal area and had a decreased pulse in the right temporal artery. A pink maculopapular rash was present on the trunk. Laboratory testing showed elevated inflammatory parameters with ESR 50. Ischaemic optic neuropathy caused by giant cell arteritis was suspected, and treatment with high dose steroids was initiated. Expanded history revealed travel to Thailand five months prior to presentation and unprotected sex with multiple female partners. A non-painful sore had developed on his penis that resolved after 14 days.
Neurosyphilis was suspected and the diagnosis was subsequently confirmed. The patient received appropriate antibiotic therapy, and four months later his vision had almost normalised.
神经梅毒是一种罕见的致盲原因，其表现可能类似于其他疾病，包括巨细胞动脉炎。
一位 60 多岁的男性因右眼视力丧失 4 天到大学医院就诊。他出现头痛、肌痛和疲劳。右眼视力仅能数到 2 米，且存在相对性传入性瞳孔障碍。他的右颞部压痛，右颞动脉搏动减弱。躯干上有粉红色斑丘疹。实验室检查显示炎症参数升高，血沉 50mm/h。怀疑是由巨细胞动脉炎引起的缺血性视神经病变，并开始用大剂量类固醇治疗。进一步询问病史发现，患者在发病前 5 个月前往泰国，与多名女性发生无保护性行为。他的阴茎上出现一处无痛性溃疡，14 天后愈合。
怀疑是神经梅毒，随后确诊。患者接受了适当的抗生素治疗，四个月后他的视力几乎恢复正常。
