pISSN 2093-2340   eISSN 2092-6448
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    Infect Chemother. 2010 Aug;42(4):262-265. Korean.
    Published online Aug 30, 2010.
    https://doi.org/10.3947/ic.2010.42.4.262
    Copyright © 2010 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Case Report

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

    Jieun Kim,1 Hyemi Jung,1 Bongyoung Kim,1 Yumi Song,2 Myungkyoo Ko,2 and 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, Email: paihj@hanyang.ac.kr
    Received May 01, 2010; Revised May 27, 2010; Accepted May 28, 2010.

    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

    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.

    References

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    MeSH Terms
    HIV
    Humans
    Incidence
    Male
    Neurosyphilis
    Optic Neuritis
    Penicillins
    Skin
    Syphilis
    Trochlear Nerve
    Trochlear Nerve Diseases
    Metrics
    Share
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