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Case Reports in Ophthalmological Medicine
Volume 2012, Article ID 621872, 4 pages
http://dx.doi.org/10.1155/2012/621872
Case Report

Neurosyphilis Presenting as Asymptomatic Optic Perineuritis

Neuro-ophthalmology Unit, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, Peoria, IL 61611, USA

Received 30 November 2011; Accepted 3 January 2012

Academic Editors: H. Atilla and S. M. Johnson

Copyright © 2012 Sarah E. Parker and John H. Pula. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Syphilis is a sexually transmitted disease that is known as “the great imitator” due to its wide variety of clinical presentations, including ocular disorders. There has been an increase in the rate of syphilis in the United States, especially in persons with HIV. We report a case of optic perineuritis in an asymptomatic male secondary to central nervous system (CNS) syphilis. Case Report. A 41-year-old man was found to have bilateral disc edema on a routine exam. Brain MRI was unremarkable, and lumbar puncture revealed a normal opening pressure, with an elevated cerebrospinal fluid white cell count. Orbit MRI showed optic nerve sheath expansion and enhancement, consistent with optic perineuritis. He tested positive for syphilis based on serum RPR and FTA-ABS. Conclusion. Ophthalmologic findings, including disc edema, may be the presenting features of CNS syphilis. Even in asymptomatic persons, perineuritis should be considered early, as diagnosis and treatment are imperative given the progressive nature of the disease.