P82 | Blurry eyes

B. Larroux¹, A. Abenante², F. Castelletti¹, M. Guerci³, H. Al Suwaidi¹, C. Binaghi¹, M. Molteni³ | ¹Medicina Interna, Università degli Studi dell’Insubria, Varese, ²Medicina Interna, Ospedale L. Confalonieri, Luino, ³Medicina Interna, Ospedale Galmarini, Tradate (VA), Italy

Background: Visual impairment is a concerning symptom for many ophthalmic and neurologic disorders. Therefore, the clinician approaching a visual loss should also consider systemic diseases.
Case presentation: A 54-year-old man suffering from a recent persistent reduction of visual acuity was sent to the Emergency Room. No pain or flushing of the eyes, nor neurological deficits. The Ophthalmologist found bilateral papilledema with some flame hemorrhages. A computed tomography angiography of the brain was then performed, excluding intracranial hypertension. Subsequently, a brain magnetic resonance ruled out any lesions, hydrocephalus, or neuroinflammatory diseases. The patient presented neither systemic involvement, malignant hypertension, nor a medical history of diabetes or toxic consumption. Since white blood cells and C-reactive protein were slightly elevated at the admission, autoimmunity and serological research for herpes viruses, HIV, Syphilis, and Borrelia were tested. The result was a strong positivity of the nontreponemal RPR test and of the treponemal-specific test TPHA, leading to a diagnosis of ocular syphilis.
Conclusions: While commonly perceived as an ‘ancient’ disease, syphilis records over 6 million new cases annually. Despite its primary association with the chancre due to prevalent sexual transmission, clinicians should avoid solely linking syphilis to its initial form. Instead, they should always consider the clinical variability of the ‘Great Imitator,’ a term coined by William Osler in the late 19th century.