Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
Department of Internal Medicine and Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.
BMJ Case Rep. 2024 Sep 10;17(9):e260588. doi: 10.1136/bcr-2024-260588.
A man in his 50s presented with a 3-week history of painless blurry vision. The ocular examination showed decreased visual acuity and 3+ bilateral papilloedema. A CT of the brain without contrast revealed a 5 mm left subdural haematoma. Anti-treponemal IgG antibodies were positive, and a reflex rapid plasma regain (RPR) was >1:64. HIV serology was negative. Ophthalmology and infectious diseases agreed that the presentation was consistent with ocular syphilis. Cerebrospinal fluid (CSF) examination revealed an elevated CSF protein of 52 mg/dL and CSF Venereal Disease Research Laboratory (VDRL) of 1:1. Penicillin was started. The patient developed a Jarisch-Herxheimer reaction soon after. He had a fever, rash and worsening headaches due to the enlargement of subdural haematoma for which he underwent a burr hole drainage. Vision improved after completing penicillin therapy but did not recover fully. The CSF VDRL became non-reactive and serum RPR titre decreased to 1:8 3 months later.
一位 50 多岁男性，3 周前出现无痛性视力模糊。眼部检查显示视力下降，双侧视盘水肿 3+。脑 CT 平扫未见造影剂增强，显示左侧硬脑膜下血肿 5mm。抗梅毒螺旋体 IgG 抗体阳性，快速血浆反应素环状卡片试验（RPR）>1:64。HIV 血清学检测阴性。眼科和传染病科医生均认为该表现符合眼部梅毒。脑脊液（CSF）检查显示 CSF 蛋白升高至 52mg/dL，CSF 性病研究实验室（VDRL）为 1:1。给予青霉素治疗。患者在开始治疗后不久出现贾第虫-赫克斯海默反应。他出现发热、皮疹和头痛加重，由于硬脑膜下血肿扩大，他接受了颅骨钻孔引流术。在完成青霉素治疗后，视力有所改善，但并未完全恢复。CSF VDRL 变为非反应性，血清 RPR 滴度在 3 个月后降至 1:8。
