1. Syphilis presenting as optic neuritis and subdural haematoma with complicating neuro Jarisch-Herxheimer reaction.
- Author
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Kaur J, Melgar TA, Abdulhak M, and Sand E
- Subjects
- Humans, Male, Middle Aged, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents adverse effects, Syphilis drug therapy, Syphilis complications, Syphilis diagnosis, Neurosyphilis drug therapy, Neurosyphilis complications, Neurosyphilis diagnosis, Tomography, X-Ray Computed, Diagnosis, Differential, Penicillins adverse effects, Optic Neuritis diagnosis, Optic Neuritis drug therapy, Hematoma, Subdural
- Abstract
A man in his 50s presented with a 3-week history of painless blurry vision. The ocular examination showed decreased visual acuity and 3+ bilateral papilloedema. A CT of the brain without contrast revealed a 5 mm left subdural haematoma. Anti-treponemal IgG antibodies were positive, and a reflex rapid plasma regain (RPR) was >1:64. HIV serology was negative. Ophthalmology and infectious diseases agreed that the presentation was consistent with ocular syphilis. Cerebrospinal fluid (CSF) examination revealed an elevated CSF protein of 52 mg/dL and CSF Venereal Disease Research Laboratory (VDRL) of 1:1. Penicillin was started. The patient developed a Jarisch-Herxheimer reaction soon after. He had a fever, rash and worsening headaches due to the enlargement of subdural haematoma for which he underwent a burr hole drainage. Vision improved after completing penicillin therapy but did not recover fully. The CSF VDRL became non-reactive and serum RPR titre decreased to 1:8 3 months later., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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