A 62-year-old woman presented with non-specific abdominal pain, elevated alkaline phosphatase levels and bilateral sequential visual loss. Visual acuity was counting fingers in right eye (RE) and 20/400 in left eye (LE). She was noted to have optic nerve pallor in RE and mildly elevated optic disc with signs of ocular inflammation in LE. After 2 weeks, vision deteriorated to light perception bilaterally with now extensive vitreal inflammation present in both eyes. Positive rapid plasma reagen and Treponema pallidum’s antibody tites confirmed syphilis infection. Unfortunately, as the diagnosis was delayed by many months, her visual acuity remained poor (hand motions in RE and 20/50 in LE) despite treatment with intravenous penicillin. This case reminds us of the re-emergence of this ‘great masquerader’ and highlights the importance of maintaining high suspicion for syphilis in patients with unexplained visual loss and systemic symptoms, even in older adults without identifiable risk factors.
- infectious diseases
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Contributors All authors contributed to the manuscript with ideas, data collection, writing and editing; and approved of the final version published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AKabanovski contributed to the interpretation and analysis of data, drafting of the manuscript and revision of the work. AKaplan contributed to the conception and ideas of the work, interpretation and analysis of data, and revision of the work. EB contributed to the conception and ideas of the work, interpretation and analysis of data, and revision of the work. EAM contributed to the acquisition of data, conception and ideas of the work, interpretation and analysis of data, drafting of the manuscript and revision of the work. EAM is also responsible for the overall content as the guarantor and is the corresponding author.
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.