Bilateral Syphilitic Optic Neuritis in a Patient With a Positive Test for HIV

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Abstract
To the Editor. —With the increasing incidence of infection with syphilis and the human immunodeficiency virus (HIV), particularly in the homosexual population,1 the clinician must be aware of the possibility of concurrent disease. We report a case that illustrates this point. Report of a Case. —A 54-year-old homosexual man presented with nausea, vomiting, and progressive loss of vision in his right eye over three days. A general physical examination was remarkable for bilateral edema of the optic discs and a perianal ulcer. Ophthalmologic consultation was undertaken. Visual acuity was 20/30 OD and 20/20 OS. A marked afferent pupillary defect was noted in the right eye. Goldmann perimetry of the right eye revealed only a 10° central island and a larger temporal island remaining. The visual field of the left eye was normal. Results of examination of the anterior segments were normal. Funduscopic examination revealed elevation of both discs (Figs

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