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目的分析神经梅毒的临床特点及误诊原因。方法对我院收治的以视力减退为唯一表现的神经梅毒1例的临床资料进行回顾性分析。结果本例因左眼视力下降6个月,右眼视力下降3个月就诊。曾在外院多次就诊,误诊为视神经脊髓炎、特发性视神经炎、血管性视神经炎等疾病,对症治疗效果差。入院查体:双眼视力下降,右眼可辨认10 cm内物体大致轮廓,左眼仅有轻度光感且直接对光反射消失。疑诊视神经脊髓炎谱系疾病(NMOSD),查NMOSD抗体阴性;行眼眶、颅脑MRI示:双侧大脑半球多发斑片状脑缺血灶,双侧视神经萎缩;眼底检查示:双侧视乳头苍白。后疑诊梅毒,查甲苯胺红不加热血清试验阳性(1∶2),梅毒螺旋体血凝试验阳性(1∶2560),血清梅毒螺旋体抗体阳性。确诊为神经梅毒,予泼尼松、苄星青霉素等治疗后症状好转出院。出院后继续予苄星青霉素治疗,1个月后患者双眼视力明显恢复。结论临床遇及以视力减退为唯一表现的患者,尤其是治疗效果欠佳者,要考虑到神经梅毒的可能,完善相关医技检查,尽早确诊,及时予对症治疗,以改善预后。
Objective To analyze the clinical features and causes of misdiagnosis of neurosyphilis. Methods The clinical data of 1 neurosyphilis treated with vision loss in our hospital were analyzed retrospectively. Results in this case due to left eye vision decreased 6 months, right eye vision decreased 3 months treatment. Have seen many times outside the hospital, misdiagnosed as optic neuromyelitis, idiopathic optic neuritis, vascular optic neuritis and other diseases, symptomatic treatment is poor. Admission examination: Binocular vision decreased, the right eye can identify the general outline of objects within 10 cm, the left eye only mild light perception and direct light reflex disappeared. Suspected neuromyelitis disease (NMOSD), check the negative of NMOSD antibody; line orbital, cranial MRI showed: multiple bilateral cerebral hemispheric focal ischemic foci, bilateral optic atrophy; fundus examination showed: bilateral optic nerve head pale. After suspected syphilis, check toluidine red unheated serum test was positive (1: 2), Treponema pallidum hemagglutination test was positive (1: 2560), serum syphilis antibody positive. Diagnosis of neurosyphilis, prednisone, benzathine penicillin and other symptoms improved after treatment. After discharge to continue benzathine penicillin treatment, 1 month after the patient binocular vision was significantly recovered. Conclusions Clinical experience and eyesight loss as the only manifestation of patients, especially those with poor treatment, we must take into account the possibility of neurosyphilis, improve the relevant medical examination, early diagnosis and timely symptomatic treatment to improve the prognosis.