We report the case of a 43-year-old male patient presenting for neuro-ophthalmologic and uveitis consultation at Clermont-Ferrand University Medical Center for a reduction in visual acuity in his right eye. Two months previously, the patient had complained of decreased hearing on the left, which remained undiagnosed. Fundus examination and fluorescein angiogram showed the appearance of vasculitis with papillitis and a choroidal plaque. TPHA-VDRL serology was positive in blood and cerebrospinal fluid. Internal medicine work-up revealed many associated abnormalities: hyperhomocysteinemia, positive anticardiolipin antibody, positive anti-β2GP1 antibodies, increased partial thromboplastin time not corrected by the addition of control plasma, presence of an anti-prothrombinase antibody, positive activated protein C resistance. ENT examination showed a left harmonic vestibular syndrome; audiography showed a sensorineural hearing loss of -40 dB. The patient received treatment for neurosyphilis, which led to the disappearance of the vasculitis, the choroidal plaque and the papillitis. From an ENT standpoint, the vestibular syndrome and the left vestibular areflexia resolved. The audiogram improved, with persistence of left hearing loss (about -20 dB) with useful speech intelligibility. Immunologic abnormalities had also disappeared. Our case illustrates the protean presentations of syphilis and its possible association with sensorineural deafness and immunological abnormalities.
Keywords: Deafness; Meningitis; Méningite; Neurosyphilis; Surdité; Syphilis; Treponema pallidum; Uveitis; Uvéite.
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