Neurosyphilis manifesting with unilateral visual loss and hyponatremia: a case report

Abstract

BackgroundSyphilis is called the chameleon of the diseases due to its variety of its clinical presentations, potentially affecting every organ of the body. Incidence of this ancient disease is once again on the increase worldwide.Case presentationWe here report an unusual case of neurosyphilis manifesting with unilateral visual loss and hyponatremia. The patient also had primary syphilitic lesions and was concomitantly diagnosed with Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Treatment with ceftriaxone and prednisolone, completely resolved the hyponatremia and visual acuity was partially restored.ConclusionAwareness of syphilis as a differential diagnosis is important as previously unreported presentations of neurosyphilis can arise, especially in HIV infected patients.

Unilateral swollen optic disc: do not forget neurosyphilis

“…Regarding the ophthalmological findings, an optic neuropathy usually, but not always, associates with a relative afferent pupillary defect. In other cases of syphilitic optic neuritis the afferent pupillary defect was also absent 10 11…”

An unusual cause for hyponatremia with seizures

“…Milger et al 5 reported a retropositive patient presenting with hyponatremia secondary to SIADH. However, the case in question had central hypothyroidism, making the diagnosis of SIADH questionable.…”

Nörosifiliz: Farklı Prezantasyonları

“…The presence of VEP pathology suggested accompanying optic nerve involvement. Syphilis has been shown to affect cranial nerves as well as very rarely cause cavernous sinus syndrome or inappropriate antidiuretic hormone (ADH) syndrome (12,13 The first case was found to have asymmetrical pupil width as well as tonic pupil response (Figures 1, 2). The electroneugraphic evaluation found the nerve conduction velocities to be normal.…”