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Título

Syphilitic Optic Neuritis

RESUMO

CASE PRESENTATION: A 46 years old male, with type 2 diabetes mellitus. He reports sudden decrease in the visual field in the right eye without other associated complaints. After 20 days without improvement, referred tot he Ophthalmology service, who found a decrease in visual acuity and papilledema on funduscopy, without impairment in oculomotricity and normal neurological exam. In the investigation, with normal laboratory tests, non-reactive viral serology, VDRL (+); FTA-Abs IgM(-) IgG (+), negative autoantibodies, CSF without pleocytosis and VDRL (-), requested brain MRI, normal, and orbits with hypersignal in the optic nerve in the orbital región on theright. He reports abaut 3 years ago. a popular lesión on the penis, painless, disappearing later, and intermittent erythematous cutaneous lesions on the extremities, without medical consultation. He remained in the ward for 14 days under treatment with Ceftriaxone – HICC guidance. After discharge, follow-up at an ophthalmic outpatient clinic with a marked reduction in eye symptoms.
DISCUSSION: Syphilis can affect the CNS at any stage of its natural history. Early neurosyphilis, less common, appears soon after syphilitic infection, and ocular involvement may be the first manifestation. As in the case described, in the presence of isolated inflammatory optic neuritis, there is no clinical finding or specific test that differentiates the syphilis lesion from other causes of optic neuritis. Optic nerve involvement can be unilateral or bilateral, leading to a decrease in visual acuity, with evidence of optic perineuritis, papillitis, neuroretinitis, retrobulbar neuritis and papilledema and the need to perform a lumbar puncture in all cases of neurological or ophthalmological symptoms and the immediately indicated treatment with antibiotictherapy. If treatment is not instituted properly, cranial nerve injuries can be permanent.
FINAL CONSIDERATION: The case shows an atypical manifestation of neurosyphilis. In this way, we emphasize the importance of paying attention to non-specific neuro-ophthalmological disorders and calling the attention to this disease that, unfortunately, still high prevalent in the population.

Palavras Chave

Neurosifilis - Neurite optica