Neurite óptica bilateral secundária a neurossífilisem paciente imunocompetente

Objective: To describe an atypical presentation of neurosyphilis, characterized by bilateral optic neuritis in an immunocompetent patient. Case Details: A 58-year-old patient, with progressive bilateralvisual loss, predominantly cecocentral, asymmetrical pupils, left larger thanrightand photomotor reflex with less reaction to the left. On ophthalmological examination, he presented bilateral optic disc edema. The investigation revealed a diagnosis of bilateral optic neuritis secondary to neurosyphilis. Treatment started with ceftriaxone due to lack of crystalline penicillin in the service, at a dose of 2 grams a day for 14 days. The patient evolved favorably, with progressive improvement of visual symptoms. Final considerations: Syphilis is a systemic disease with a wide variety of signs and symptoms. These characteristics increases the risk of errors in diagnosis and treatment, with relevant repercussions on morbidity and mortality. Isolated optic neuritis associated with neurosyphilis is an uncommon presentation of the disease, and can be a diagnostic challenge for medical staff.