A case of syphilitic uveitis with juvenile cerebral infarction twice in one year
Purpose
Introduction:
Syphilis is an infectious disease that can be fatal to the central nervous and cardiovascular systems. Here we report a case of syphilitic uveitis in a relatively young patient with poor atherosclerotic risk factors who developed medial medullary infarction twice in one year.
Methods
Case:
A 48-year-old male, who had experienced left medial medullary syndrome one year earlier, presented to our emergency clinic with blurry vision in the right eye for three days, and paralysis of the left lower limb and nausea for a day. A head MRI revealed right medial medullary syndrome and a blood test was positive for syphilis. A CSF test was also positive for syphilis, and he was diagnosed as neurosyphilis. Visual acuity in the right eye was 20/63. There were vitreous opacity, retinal hemorrhage, and retinochoroidal atrophy. Treatment was started with penicillin G infusion and oral steroids. With treatment, neurological symptoms and vitreous opacity improved. However, choroidal neovascularization (CNV) and subretinal fluid were observed in the macula at 6 weeks after treatment, and anti-VEGF medication was started. CNV improved after a total of three injections.
Results
Discussion:
Within a year, the patient suffered infarcts in proximal areas, suggesting cerebral infarction caused by meningovascular type neurosyphilis rather than the usual arteriosclerotic cerebral infarction. In addition, the patient had inflammatory CNV, an uncommon complication of syphilitic uveitis.
Conclusion
Conclusion:
Syphilis can cause fatal complications such as cerebral infarction. When a patient with syphilis first presents to an ophthalmologist, a proper diagnosis and referral to an infectious disease physician is necessary.
Conflict of interest
No
Authors 1
Last name
TANIKAWA
Initials of first name(s)
A
Department
Department of Ophthalmology, Yodogawa Christian Hospital
City
Osaka
Country
Japan
Authors 2
Last name
NAKAI
Initials of first name(s)
K
Department
Department of Ophthalmology, Yodogawa Christian Hospital
City
Osaka
Country
Japan
Authors 3
Last name
Abe
Initials of first name(s)
Y
Department
Department of Neurology, Yodogawa Christian Hospital
City
Osaka
Country
Japan
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