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Neurosyphilis in a suspected case of giant cell arteritis
  1. Annalisa Montebello1,
  2. Daniela Harmsworth2,
  3. Paul John Cassar2,3 and
  4. Sandro Vella1,3
  1. 1 Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
  2. 2 Rheumatology and General Internal Medicine, Mater Dei Hospital, Msida, Malta
  3. 3 University of Malta Medical School, Msida, Malta
  1. Correspondence to Dr Annalisa Montebello; annalisamontebello{at}


A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.

  • neuroimaging
  • syphilis

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  • Contributors AM and DH wrote the case with constant guidance and reviews by PJC and SV.

  • 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.