罕见梅毒性视神经周围炎1例(英文)

Syphilitic optic perineuritis:a case report of a rare presentation

目的:报告1例罕见的由梅毒感染引起的视神经周围炎,经皮质类固醇治疗后严重视力缺损得到显著改善。方法:病例报告。结果:一名66岁马来裔女性患者来我院就诊,一眼突然出现视力缺损,动眼时有疼痛感。视力无光感,右眼出现相对性瞳孔传入缺陷(relative afferent pupillary defect,RAPD)。血清学和放射学检查证明为梅毒性视神经周围炎。肌肉注射苄星青霉素,静脉注射甲基醋酸泼尼松龙,然后长期口服类固醇,剂量逐渐降低。经过治疗,患者视力明显提高,恢复到6/18。随访4mo,未出现复发和类固醇相关的副作用。结论:本病诊断正确、治疗及时,能使患者视力得到显著改善。

AIM： To report a rare case of optic perineuritis secondary to syphilis infection with severe visual loss showing a dramatic improvement following treatment with corticosteroids. METHODS： Case report. RESULTS： A 66-year-old Malay lady presented to us with sudden onset of unilateral loss of vision and pain on eye movement. Her vision had no perception of light and marked relative afferent pupillary defect （RAPD） was present over the right eye. Serological and radiological investigation showed evidence of syphilitic optic perineuritis. She was treated with intramuscular benzathine penicillin and intravenous methyl prednisolone, followed by oral steroid with tapering dose for long period. Her visual acuity improved remarkably after the treatment. She regained the vision of 6/18 and there was no sign of recurrence or steroid related side effects during 4 months follow-up. CONCLUSION： Accurate diagnosis and prompt treatment of this case has converted a poor vision to a better visual outcome.