PMC3033331_01
Optical coherence tomography (OCT) image of the left eye. Upper image: optic disk swelling (red arrow) at presentation. Lower image: Red arrow points to the former optic disk swelling that is resolved after three weeks of treatment.
1471-2334-11-17-1.jpg
PMC3033331_01_1471-2334-11-17-1.jpg
F1
Fundoscopic examination showed swelling of the optic disk and serous retinal detachment in the left eye (Figure 1, upper image). Visual acuity also improved markedly from 0.02 to 0.2 and papillitis was no longer present after 3 weeks of treatment (Figure 1, lower image).
Syphilitic lesions at presentation. Upper left image: Perioral syphilitic lesion. Upper right image: Genital syphilitic lesion. PCR of smears confirmed presence of Treponema pallidum in both locations. Lower Image: CT scan: marked genital and scrotal oedema and inguinal lymphadenopathy.
1471-2334-11-17-2.jpg
PMC3033331_01_1471-2334-11-17-2.jpg
F2
In addition to the oral lesions, multiple painless, hard-edged ulcers and oedematous swelling were found on the penis and scrotum (Figure 2, upper right image). A computed tomography (CT) scan showed generalized lymphadenopathy, moderate enlargement of liver and spleen, and extension of the genital oedema to the lower abdominal wall (Figure 2, lower image).
Plasma sodium concentration. On the day of presentation oral sodium chloride substitution and water restriction were started. Sodium concentration normalized rapidly after the start of ceftriaxone treatment while sodium chloride substitution was not increased.
1471-2334-11-17-3.jpg
PMC3033331_01_1471-2334-11-17-3.jpg
F3
A therapeutic response to syphilis treatment was observed with normalization of sodium levels (Figure 3), healing of oral ulcers and improvement of the patient's general condition within one week.