Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
Rheumatology and General Internal Medicine, Mater Dei Hospital, Msida, Malta.
BMJ Case Rep. 2021 Sep 8;14(9):e242733. doi: 10.1136/bcr-2021-242733.
A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.
一位 67 岁男性出现数月视力逐渐下降的病史。他最初因右眼视力模糊就诊于眼科。随后左眼也出现同样的症状。此时，他经验性地接受了大剂量糖皮质激素（口服和静脉）治疗，疑似巨细胞动脉炎导致左眼急性视力下降。然而，他的症状并未改善。在因肺炎住院期间，他因双侧视力丧失进一步接受了检查。他被诊断为左眼神经视网膜炎和右眼玻璃体炎。全面检查发现梅毒血清学阳性，性病研究实验室检查脑脊液阳性。他被诊断为神经梅毒，并接受了 14 天的静脉注射苄星青霉素 400 万单位、每 4 小时 1 次的治疗。他的左眼视力有所改善，但右眼仍严重视力受损。
