49-year-old woman with blind spot diagnosed with neurosyphilis

A patient presented to hospital with a severe headache, blurred vision and an aversion to light

Image of the retina

A US woman who presented to hospital in Missouri with a blind spot, blurred vision and photophobia was diagnosed with neurosyphilis.

Writing in BMJ Case Reports, clinicians highlighted that an MRI revealed the 49-year-old patient had optic neuritis of the right optic nerve.
Her visual acuity was 6/21 in her right eye and 6/6 in the patient’s left eye.

She was treated with steroids. After symptoms persisted, a lumbar puncture was performed, and cerebrospinal fluid analysis tested positive for venereal disease. 

The patient recalled becoming ill with a diffuse rash between one to two months before coming to hospital.

Following a diagnosis of neurosyphilis, the patient was treated with a two-week course of daily intravenous penicillin.

Five weeks after treatment she reported that almost all of her ocular symptoms had resolved.

Her visual acuity at five months was 6/7.5 in her right eye and 6/6 in her left eye.

Image credit: BMJ Case Reports 2018