UNILATERAL LOSS OF VISION AS THE PRESENTI NG FEATURE OF NEUROSYPHILIS- A CASE-REPORT

A 55 year-old patient developed loss of vision in his right eye over a period of a few weeks with the clinical finding of uveitis and papill aedema. Subsequently, also the left eye was affected by a marked deter ioration of vision. The neurological findings were normal. The laborat ory findings showed a marked elevation of the ESR (> 100 mm within the first hour) and protein electrophoreses showed changes suggestive of chronic inflammation. Analysis of the cerebrospinal fluid revealed a l ymphocytic meningitis with 180/3 cells; the positive serological and l iquor findings for TPHA and FTA led to the definite diagnosis of neuro syphilis. Treatment intravenously with 3 x 4 million units penicillin G daily for a fortnight proved curative. Vision of the left eye recove red fully, but the ophthalmological changes in the right eye were irre versible. This case shows that even today the differential diagnosis o f syphilis must be considered with loss of vision of doubtful aetiolog y and uveitis.