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Impressum
Neuritis Nervi Optici as first symptom of Neurosyphillis
Koop G., Schmidt W.,Discher T.
Zentrum für Augenheilkunde, Friedrichstr. 18, 35392 Gießen
Objective: The differential diagnosis of papillitis with sudden
deterioration of visual acuitiy includes a wide range of ophthalmological,
neurological and internal diseases. Systemic infections as Syphillis are
a rare cause, although it accounts for up to 2.45% of Uveitis and the
rate of new infections in the US was 17.3 per 100.000 inhabitants in 1991.
Methods: We hereby report the case of a 59 year old caucasian man
who primarily presented himself with acute deterioration of visual acuity
in his right eye on Jan. 4th 2001. At the same time he had also noticed
diffuse alopecia, bilateral reduction of hearing and a rash on both hands
and the back. Before he claimed to have been entirely healthy. On admission
the best-corrected visual acuity was 0.5 at the right eye, the right papilla
was prominently swollen with nasal dominance. A colour desaturation at
the right eye could be found as well as a relative central scotoma on
that side in the perimetry. Of neurological interest was the bilateral
reduction of reflexes and a predominance of lymphocytes in an elevated
CSF cell count. Serological findings included HBs- und HBc-antibodies
as reminders of a former hepatits B infection. The further serodiagnosis
including HIV and HCV was negative. The positive Lues-serodiagnosis led
to the diagnosis. Already during ongoing therapy with 3 x 10 Mio U. Penicillin
G ( for 16 days ) the patients visual acuity recovered to 1,0 while still
presenting a prominence of the papilla. The latter was significantly reduced
until the last control on Feb. 13th . By then, the perimetric changes
were also gone and the lues-antibody-titers visibly reduced.
Discussion: The presented case clearly showes the relevance of
serological tests in patients with papillitis and neuritis nervi optici.
Although the incidence of lues has steadily fallen since the introduction
of antibiotic therapy, a test should not be missed in such patients, as
by early diagnosis and proper treatment it is well possible to save a
patients full visual acuity.