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Optic neuritis caused by the re-emerging great masquerader
  1. Nathanial S Nolan1,
  2. Laura E Gibbons2,
  3. Madihah A Hepburn3,
  4. Ahmed Elkeeb4 and
  5. Hariharan Regunath5
  1. 1 Internal Medicine, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
  2. 2 Internal Medicine-Pediatrics, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
  3. 3 Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
  4. 4 Department of Ophthalmology, University of Missouri Columbia, Columbia, Missouri, USA
  5. 5 Department of Medicine, Divisions of Pulmonary, Critical Care Medicine and Infectious Diseases, Columbia, Missouri, USA
  1. Correspondence to Dr Nathanial S Nolan, nolann{at}


A 49-year-old Caucasian woman presented with subacute headache and right eye pain associated with scotoma, blurred vision and photophobia. MRI was suggestive of optic neuritis of the right optic nerve and she was treated with steroids. Due to persistent symptoms, a lumbar puncture was performed and cerebrospinal fluid analysis was positive for venereal disease research laboratory and rapid plasma reagin titres. On further history, she recalled experiencing an illness associated with diffuse rash, likely secondary syphilis, 1–2 months prior. She tested negative for HIV. She was treated with intravenous penicillin for 2 weeks following which she experienced improvement in symptoms.

  • infectious diseases
  • infection (neurology)
  • retina
  • neuroopthalmology

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  • Patient consent for publication Obtained.

  • Contributors All authors participated in the care of the patient as well as the conception and authorship of the manuscript. NSN and LEG performed literature review and authored the manuscript in regard to syphilis infection and treatment. MAH provided expertise and authorship in regard to optic neuritis. AE and HR provided critical insight and editing to the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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