Neurosyphilis causing bilateral optic perineuritis

Introduction: Optic perineuritis is a rare disorder with multiple possible etiologies, including systemic autoimmune or infectious syndromes and, more rarely, neurosyphilis. The aim of this report is to describe an uncommon manifestation of this reemerging infectious disease. Case report based on a retrospective analysis of the medical records of the patient. Case report: A previously healthy 35-year-old female presented to the hospital with a seven-day history of progressive right eye vision loss and pain on extraocular movement, with development of a pink maculopapular rash on the trunk. On the sixth day of her disease, similar symptoms appeared in the contralateral eye. Physical examination showed reduced fotomotor reflex and finger counting at 50 cm in both eyes. Magnetic resonance imaging revealed bilateral and circumferential thickening with enhancement of the optic nerve sheath, suggesting bilateral optic nerve perineuritis. Serum Venereal Disease Research Laboratory (VDRL) was 1/64 and cerebrospinal fluid (CSF) showed 440 cells (86% lymphocytes), proteins 97 mg/dL, glucose 47 mg/dL, lactate 21 mg/dL and VDRL 1/4. She was treated with IV crystalline penicillin for 21 days and had partial improvement of bilateral vision within two months. At follow-up, her visual acuity was 20/40 in the right eye and 20/100 in the left; her CSF normalized, with nonreactive VDRL. Conclusion: Neurosyphilis is a treatable cause of optic perineuritis, and its recognition is important to establish the right antibiotic treatment.