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Título

Optic neuroretinitis in an HIV-seropositive patient: case report

RESUMO

Optic neuroretinitis in an HIV-seropositive patient: case report

Case related: Male, 27 years old, white, initially searched an outpatient clinic due to painless and non-pruritic erythematous macules on the soles of the feet and palms, being diagnosed with syphilis, and later as a carrier of the human immunodeficiency virus (AIDS)/HIV, and treatment was started for both diseases (first line for AIDS, and for secondary syphilis according to the protocol of the Brazilian Institute of Health. After 30 days, he began to complain of floaters in the right eye (OD), in addition to fixed scintillating scotomas in the left eye (LE), painless and referred to a secondary hospital for suspected neurosyphilis. On examination of the eye fundus (FO), papilla edema and signs of retinitis in the RE were observed. During etiological investigation, brain magnetic resonance imaging and cerebrospinal fluid (CSF) were normal (negative VDRL). A diagnosis of syphilis neuroretinitis was defined and the patient received intravenous crystalline penicillin for 14 days, with total regression of symptoms. Discussion: Acquired syphilis can be classified as primary, secondary and tertiary, being more frequent and more severe among HIV carriers, and in this case, it may present clinical manifestations of two stages simultaneously. T. pallidum is invasive and can affect the central nervous system at any stage of infection. Neurosyphilis is more frequent in HIV carriers, especially in those without antiretroviral therapy. Ocular syphilis, on the other hand, is an uncommon form and early manifestation of syphilis, at any stage of the disease, and can be confused with optic neuritis and neurosyphilis. Uveitis and optic neuritis are common to all patients with ocular syphilis, but some studies suggest that HIV-infected patients tend to have acute posterior uveitis, and particularly posterior chorioretinitis, as we observed in this patient. Final comments: Ocular syphilis has different clinical spectra and can manifest at any stage of the disease, thus, it should be part of the differential diagnoses of retinitis, optic neuritis and especially neuroretinitis in HIV positive patients. Early diagnosis and treatment of neuroretinitis will prevent permanent visual loss.

Palavras Chave

HIV-seropositive/ Optic neuroretinitis/ acute posterior uveitis/ neurosyphilis.

Área

Neuroinfecção