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Título

Simultaneous ocular and otologic syphilis in a HIV-infected patient: a case report

RESUMO

Case Report: A 53-year-old male patient presented with bilateral rapidly progressive painless visual loss for nine days, associated with bilateral hearing loss, was admitted in our emergency service. The comorbidities were HIV infection with a CD4 count of 217 cells/mm3 and undetectable viral load.
The neurological examination findings an important reduction of the visual acuity with light perception and vision of counting fingers bilateral. Also a papilledema bilateral with normal photomotor reflex and isochoric pupils. A hearing loss and a tinnitus complaint were present on admission, however no specific tests were performed. No pathological findings were found on cranial CT. CSF analysis demonstrated white cell count of 4 cels/uL, appropriate level of glucose, protein levels 87 mg/dL and a non treponemic test (VDRL) negative. Due to the optic neuritis hypothesis, a brain and orbital MRI was requested and no abnormalities were identified. An ophthalmological evaluation was made with the retinal mapping showing an elevated and hyperemic optic disc with blurred edges 360 degrees, especially in the left eye. A mild macular edema, secondary to papilledema, was present, normal blood vessels and no exudative or hemorrhagic lesions were present.
To assess the etiology, the laboratory was screened for infectious agents such as toxoplasmosis and cytomegalovirus, all of which were negative. The serum treponemal test was reactive and the VDRL result was 1:128. Based on the presence of ocular and otological involvement the hypothesis of simultaneous ocular syphilis and otosyphilis was made.
The patient received intravenous therapy with ceftriaxone for 14 days, aqueous crystalline penicillin G was unavailable. A gradual improvement of signs and symptoms were presented with partial recovery of visual acuity and resolution of otological complaints. The patient was discharged for outpatient follow-up.
Discussion: CNS involvement can occur at any stage of syphilis. Among patients with secondary syphilis, 18% may have neurological symptoms. Syphilis has a wide variety of clinical forms, it can affect the ocular or auditory level. Only one previous case found in the literature presents a clinic similar to this one.Syphilis affecting the auditory system is an uncommon but underdiagnosed condition.
Final comments: Although rare, this report is of great value to review the importance of differential diagnosis in neuroinfectology. Ethics Committee No:5397799

Palavras Chave

Syphilis; Infections; HIV Wasting Syndrome