A Case of Neurosyphilis with Acute Optic Neuritis and Trochlear Nerve Palsy in Human Immunodeficiency Virus Infected Male

Jieun Kim; Hyemi Jung; Bongyoung Kim; Yumi Song; Myungkyoo Ko; Hyunjoo Pai

doi:10.3947/ic.2010.42.4.262

Journal List > Infect Chemother > v.42(4) > 1035023

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Kim, Jung, Kim, Song, Ko, and Pai: A Case of Neurosyphilis with Acute Optic Neuritis and Trochlear Nerve Palsy in Human Immunodeficiency Virus Infected Male

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2010; 42(4): 262-265.

Published online: 30 August 2010

DOI: https://doi.org/10.3947/ic.2010.42.4.262

A Case of Neurosyphilis with Acute Optic Neuritis and Trochlear Nerve Palsy in Human Immunodeficiency Virus Infected Male

Jieun Kim¹, Hyemi Jung¹, Bongyoung Kim¹, Yumi Song², Myungkyoo Ko², Hyunjoo Pai¹

¹Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

²Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.

Correspondence to Hyunjoo Pai, M.D. Department of Internal Medicine, Hanyang University College of Medicine, 17 Haengdang-dong Seoungdong-gu, Seoul 133-792, Korea. Tel: +82-2-2290-8356, Fax: +82-2-2298-9183, paihj@hanyang.ac.kr

Received 1 May 2010 Revised 27 May 2010 Accepted 28 May 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

With the increase in human immunodeficiency virus (HIV) infection, the incidence of syphilis also increased worldwide presenting with diverse clinical manifestations. We experienced a case of symptomatic early neurosyphilis manifesting as optic neuritis and trochlear nerve palsy with typical skin lesions of secondary syphilis in an HIV-Infected patient. Intravenous penicillin and oral steroid were administered for 2 weeks. Skin lesions improved after a week, and ocular lesions resolved completely after eight weeks of treatment.

Keywords: Neurosyphilis, Optic neuritis, Trochlear nerve palsy, Human immunodeficiency virus (HIV)

Figures and Tables

Figure 1

The patient has multiple erythematous scaly annular plaques on the scrotum (A), palm (B), and sole (C).

Figure 2

At the time of diagnosis, right eye demonstrates severe papillary edema with surrounding neuroretinal edema. The retinal vein is slightly dilated. Hyperemic appearance and peripapillary splinter hemorrhage suggest an acute condition.

Figure 3

After 3 days of treatment, there is no improvement in the right eye.

Figure 4

Two weeks after the treatment with penicillin and steroid, right papillary edema has improved and peripapillary retinal vasculature returns to normal. However, mild disc hyperemia is still seen.

Figure 5

Eight weeks after the treatment, right eye shows sharp disc margin and normal pinkish color.

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