Título / Title

BILATERAL OPTICAL NEURITIS SECONDARY TO NEUROSIFILIS WITH LATE DIAGNOSIS BY USE OF SYSTEMIC CORTICOTHERAPY AS SELF-MEDICATION

Introdução / Purpose

Syphilis is an infectious disease that remains a public health problem. The aim of this study is to report a case of bilateral optic neuritis caused by neurosyphilis with late diagnosis due to the use of systemic corticotherapy as self-medication.

Material e Método / Methods

This is a case report with a prospective literature review.

Resultados / Results

Male, caucasian, 52 years old, complaining of blurred vision and subacute eye pain. Previously, skin lesions and genital lesions with self-medication - prednisone 20 mg/day - for suspected urticaria. Upon examination, 20/200 in the right eye (OD) and 20/50 in the left eye (OS). Bilateral light-near dissociation and relative afferent pupillary defect in OD. Non-granulomatous keratic precipitates, anterior chamber reaction/flare in both eyes (OU). Manual campimetry: cecum-central scotoma in OD and enlargement of the blind spot in OS. Bilateral disc edema associated with hyperautofluorescent foci/signs of retinal pigment epithelium granularity in the macular region in OU. Reagent VDRL and FTA-ABS test. Diagnosis of optic neuritis and bilateral panuveitis secondary to syphilis. Treatment with crystalline penicillin plus oral prednisone. As the VDRL was still elevated, intravenous ceftriaxone was indicated. After 3 months of treatment, visual acuity 20/25 in OU.

Discussão e Conclusões / Conclusion

Usually, syphilis-associated uveitis causes an intense reaction in the anterior segment, formation of posterior synechiae and can lead to the development of cataracts and glaucoma, due to the intense inflammatory process. Diagnosis and treatment of ocular syphilis must be early and immediate to avoid complications and reduce the chances of irreversible damage to vision. In this case report, the patient had his diagnosis and treatments postponed, as he had no medical evaluation in the initial phase of the systemic disease. Self-medication performed by the patient delayed the diagnosis, leading to ocular syphilis. Even with proper treatment, recurrence of the disease is possible and the patient must be followed up.

Palavras Chave

Ocular syphilis; Neurosyphilis; Optic neuritis;

Area

CLINICAL RETINA