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Infectious Diseases
Syphilis presenting as optic neuritis and subdural haematoma with complicating neuro Jarisch-Herxheimer reaction
  1. Jaspreet Kaur1,
  2. Thomas A Melgar2,
  3. Munzer Abdulhak3,4 and
  4. Emma Sand5
  1. 1Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  2. 2Department of Internal Medicine and Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
  3. 3Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  4. 4Bronson Methodist Hospital, Kalamazoo, Michigan, USA
  5. 5Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  1. Correspondence to Dr Jaspreet Kaur; jashanranu199{at}gmail.com

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.

  • Syphilis
  • Infectious diseases

https://doi.org/10.1136/bcr-2024-260588

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: TAM, JK, ES and MA. The following authors gave final approval of the manuscript: TAM, JK, ES and MA.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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