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.