A Rare Case of Ocular Syphilis with Syphilitic Cerebral Mycotic Aneurysm: A Case Report

Abstract

Infection of the central nervous system in a syphilis patient is known as neurosyphilis. Dire consequences can lead to both ocular morbidity and mortality. Due to the lack of specific symptoms associated with this disease, neurosyphilis poses a challenge to diagnosis.The management of syphilitic uveitis has remained controversial among physicians, as it is debatable whether ocular syphilis is a subtype of neurosyphilis. A 49-years-old male presented with two weeks history of sudden onset of painless, generalized blurring of vision of the left eye with a visual acuity of 6/6 over the right eye and 1/60 over the left eye. Slit lamp examination revealed a normal bilateral anterior segment however fundus examination of the left eye showed hyperemic and swollen optic discs with macula star. An infectious screening panel revealed a serum rapid plasma reagin (RPR) titre of 1:256 and raised erythrocyte sedimentation rate (ESR) of 88 mm/h. Leptospirosis, bartonella, toxoplasmosis and viral screening serologies were negative. Lumbar puncture was normal with negative CSF VDRL. Computed tomography angiography scan showed a fusiform aneurysm of the M2 segment of right middle cerebral artery (MCA). In keeping with the current examination findings, blood investigations and imaging test, the patient was diagnosed with ocular syphilis with syphilitic cerebral mycotic aneurysm and was treated with intravenous aqueous crystal penicillin G. Cerebral angiogram done after completion of antibiotics revealed resolved vascular malformation. Syphilis has the ability to mimic different ocular diseases, and this can lead to a misdiagnosis and also a delay in appropriate antimicrobial treatment.