Bilateral swelling of the optic disc in a patient with lues cerebrospinalis

Background: Nowadays luetic infections are rarely seen by ophthalmologists. We report on an immunocompetent ophthalmologically asymptomatic patient wi th bilateral papilledema due to perineuritis optici in lues cerebrospinalis . Patient: A 47-year old female patient presented with presbyopic complaints. Additionally she reported occasional dizziness with nausea and hearing los s with tinnitus. Visual acuity measured 16/20. There was a bilateral promin ent optic disc with indistinct margins and papillary hemorrhagies on the ri ght side and corresponding enlargement of the blind spot in the visual fiel d. Echography revealed bilateral optic drusen. Serological examination sugg ested lues (TPHA 1:5120, IgM-FTA-Abs-Test 1:320, Cardiolipin 1:640). Cerebr ospinal fluid examination indicated an inflammatory process in the CNS with out proof of an autochthonous antibody production. Conclusion: Even nowadays lues cerebrospinalis must be suspected in patient s with bilateral papilledema without visual loss. The ophthalmologist holds an important diagnostic position, because adequate treatment is able to pr event disease progression.