Neurosyphilis Presenting with Papillitis

Syphilis is one of the oldest described infectious diseases in the world and is caused by the spirochete bacterium Treponema pallidum([1]). Although now a rare disease, incidence is increasing with the number of diagnoses of the disease rising in England from 1688 to 2713 between 2003 and 2012 (a 61% increase)([2]). Major outbreaks of syphilis have been documented in London, Manchester, Dublin, and Brighton particularly among men who have sex with men (MSM)([3]). Diagnosis remains difficult on account of multi-system symptoms, duration of the condition, and social stigma. LEARNING POINTS: Normal CSF pressure with indistinct optic disc margins suggests papillitis, not papilloedema. Neurosyphilis can cause various ocular symptoms and is a cause of unexplained high ESR. When treating with penicillin, the physician should be aware of a potential Jarish-Herzheimer reaction.