Bilateral Papillitis

A 66-year-old man presented to Bascom Palmer with complaints of blurry vision in both eyes for three days which he described as painless. Vision was 20/350 in the right and 20/200 in the left eye with evident papillitis in both eyes on exam. An MRI revealed no retrobulbar optic neuritis and confirmed enhancement of the optic nerve heads of both eyes. The patient was found to have serologic evidence for syphilis and Lyme disease, in addition to potential CNS involvement based on CSF analysis. The patient received a two-week course of IV penicillin. One week following treatment of presumed papillitis secondary to either syphilis, Lyme disease, or both, the patient improved subjectively, and visual acuity improved to 20/100 in the right and 20/80 in the left eye.

Presentation Date: 05/14/2020

Issue Date: 08/01/2020