Neurosyphilis concurrently involving eye and ear: BMJ case r
A 42-year-old woman presented with a 2-month history of bilateral decreased and blurry vision accompanying mild photophobia. She had had several episodes of unsafe sex and was diagnosed with secondary syphilis 10 months prior. Despite the diagnosis, she did not undergo any treatment for the infection.

An ophthalmological examination revealed bilateral macular oedema, suggesting the development of uveitis. Laboratory data for complete blood counts and chemistry were unremarkable, but there were elevations of rapid plasma reagin (RPR) test and Treponema pallidum haemagglutination test (TPHA) titres, at 1:32 and 1:5120, respectively, leading to the diagnosis of ocular syphilis.

Screening tests for hepatitis B virus, hepatitis C virus and HIV yielded negative findings. Further cerebrospinal fluid examination indicated a complication of neurosyphilis, with a mildly elevated white cell count (0.013×109/L), protein level (49 mg/dL), and positive RPR (1:4) and TPHA (1:320) titres. The patient was scheduled to be hospitalised in order to undergo intravenous treatment. Before admission, the patient suddenly experienced hearing deficit.

The Weber test showed lateralisation to the right ear and the Rinne test was positive in the left ear, suggesting a left sensorineural hearing deficit, which was proven by an audiogram. Brain MRI did not show any remarkable findings in her brain. Having been diagnosed with ocular and otosyphilis, aqueous penicillin G (24 million units per day) was administered along with prednisone (0.5 mg/kg). After completing 14 days of antibiotic therapy, the patient was discharged without any complications.

Her visual symptoms improved, and macular oedema and loss of ellipsoid zone were dramatically improved. The auditory dysfunction resolved as well. After 4 months of treatment, serum titres of RPR decreased to 1:8.

Read more here: