초진 당시 허혈성 시신경병증으로 오진되었던 매독성 시신경병증 = Syphilitic Optic Neuritis Initially Misdiagnosed as Ischemic Optic Neuropathy

다국어 초록 (Multilingual Abstract)

Purpose: To report a syphilitic optic neuritis case, initially misdiagnosed as arteritic ischemic optic neuropathy (AION), in which prior transient posterior placoid chorioretinitis was an important clue to the correct diagnosis.
Case summary: A 50-year-old man presented with blurry vision in the right eye. Funduscopy revealed optic disc swelling. Due to an elevated erythrocyte sedimentation ratio and C-reactive protein, our initial impression was AION. However, the diagnosis was corrected after reviewing a previous fundus photo revealing a large, pale yellow placoid lesion in the macula of the right eye. Serological examinations revealed confirmed syphilis infection. After a 2-week treatment with penicillin G, visual symptoms and signs fully resolved.
Conclusions: Optic neuropathy with an elevated erythrocyte sedimentation ratio and C-reactive protein should prompt suspicion for syphilitic optic neuritis. Misdiagnosis as AION could lead to steroid therapy without antibiotics, which can worsen prognosis.