Case Presentation: A 73-year-old male presented with acutely worsening left eye pain, lacrimation and swelling which had progressed over 3 days. He reported non-traumatic acute onset of left eye blindness 3 weeks prior to that, with no associated headache, fevers, chills or other constitutional symptoms. The patient had early cataracts, and an otherwise uneventful ocular history (no diabetic retinopathy). The patient recently separated from his wife and lives alone; per his family, he has had increasing interaction with homeless male “friends” who he pays for ‘unknown services’. Initial workup showed reactive RPR, 1:2048 titer, Syphilis IgG/IgM reactive, with VRDL positive CSF.
Discussion: The CDC reported a resurgence in incidence of syphilis in 2000. Ocular syphilis, a subtype of neurosyphilis, however remains fairly uncommon, with notable clusters of cases in 2015. According to the CDC, ‘a total of 388 suspected ocular syphilis cases were identified, 157 in 2014 and 231 in 2015. Overall, among total syphilis surveillance cases in the jurisdictions evaluated, 0.53% in 2014 and 0.65% in 2015 indicated ocular symptoms, ranging from uveitis, optic neuropathy, and other vision-threatening conditions.We report the case of a 74-year-old male presenting with progressively worsening optic neuritis, preceded by acute onset left eye blindness. The patient was found to be RPR seropositive, with VDRL positive CSF on lumbar puncture. As seen in the review of five jurisdictions by the CDC, this case was consistent with the increased proportion of incidence of syphilis in men who have sex with men (MSM).
Conclusions: This case highlights the need for a thorough serologic diagnostic workup in patients presenting with ocular symptoms suggestive of ocular syphilis. Further testing, including HIV, hepatitis and other STIs is indicated in completing the diagnosis and structuring a thorough treatment plan.