A Case of Optic Atrophy with Neurosyphilis

DOI
  • Watanabe Toshiki
    Department of Ophthalmology, Kyorin University School of Medicine Watanabe Eye Clinic
  • Kigasawa Kazuteru
    Department of Ophthalmology, Kyorin University School of Medicine
  • Miyazaki Tai
    Department of Neurology, Kyorin University School of Medicine
  • Hirakata Akito
    Department of Ophthalmology, Kyorin University School of Medicine

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Other Title
  • 視神経萎縮で発見された神経梅毒の一症例

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We report a case of neurosyphilis that was found to be associated with optic atrophy without any other neurological signs. The patient was a 59-year-old man with a 3-year history of progressive bilateral visual loss with optic atrophy of unknown origin. His corrected visual acuity was hand movement in the right eye and 0.1 in the left eye. He had a limited residual visual field in inferotemporal region of the right eye, and central and inferior scotoma in the left eye. Optic nerve head atrophy was present in both eyes. Light-near dissociation was detected in both eyes, but there was no evidence of miosis. Neuroimaging revealed optic nerve atrophy, but there were no abnormal findings suggestive of a compressive lesion. Tests for serum and cerebrospinal fluid anti-syphilitic antibodies were positive. The cerebrospinal fluid cell count was high. HIV antibody was negative. As a result of these findings, we diagnosed neurosyphilis with optic atrophy. The patient was treated with penicillin intravenously for 2 weeks. Visual acuity and visual field did not improve, but serum and cerebrospinal fluid anti-syphilitic antibodies and the cerebrospinal cell count decreased. Syphilitic optic atrophy is a rare condition with a poor visual prognosis. Clinicians should be aware that optic atrophy can be caused by syphilis.

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