Bilateral Syphilitic Optic Neuritis in a Patient With a Positive Test for HIV

Abstract

<h3>To the Editor.</h3> —With the increasing incidence of infection with syphilis and the human immunodeficiency virus (HIV), particularly in the homosexual population,¹the clinician must be aware of the possibility of concurrent disease. We report a case that illustrates this point. <h3>Report of a Case.</h3> —A 54-year-old homosexual man presented with nausea, vomiting, and progressive loss of vision in his right eye over three days. A general physical examination was remarkable for bilateral edema of the optic discs and a perianal ulcer. Ophthalmologic consultation was undertaken. Visual acuity was 20/30 OD and 20/20 OS. A marked afferent pupillary defect was noted in the right eye. Goldmann perimetry of the right eye revealed only a 10° central island and a larger temporal island remaining. The visual field of the left eye was normal. Results of examination of the anterior segments were normal. Funduscopic examination revealed elevation of both discs (Figs