# Unilateral Central Retinal Vein Occlusion in a Young Adult With Latent Syphilis

## TL;DR

A young man with latent syphilis developed retinal vein occlusion, which improved after treatment with penicillin.

## Contribution

Highlights a rare case linking latent syphilis to central retinal vein occlusion in a young adult.

## Key findings

- CRVO occurred in a 24-year-old with latent syphilis confirmed by TPPA and RPR tests.
- Treatment with benzathine penicillin improved visual acuity significantly within four weeks.
- CSF VDRL was non-reactive, indicating no neurosyphilis involvement.

## Abstract

Central retinal vein occlusion (CRVO) is a significant retinal vascular disease that commonly affects the elderly. Given its rarity among the younger population, its presence should alert clinicians to the possibility of a serious systemic disease. We highlight a rare case of CRVO in a young adult with latent syphilis. Our patient is a 24-year-old male who presented with acute, right eye painless blurring of vision for one day. His right and left visual acuity (VA) were hand movement and 6/6, respectively. Relative afferent pupillary defect (RAPD) was negative. Right fundus examination revealed a hyperemic optic disc with dilated tortuous retinal vessels and multiple flame-shaped, dot, and blot hemorrhages. Laboratory investigations showed a positive Treponema pallidum particle agglutination (TPPA) and reactive rapid plasma reagin (RPR) with a titer of 1:16 and a weakly positive anti-cardiolipin antibody, which became negative after repeating at 16 weeks and 32 weeks. Cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test was non-reactive. The patient was diagnosed with central retinal vein occlusion (CRVO) secondary to latent syphilis. A total of three doses of intramuscular benzathine penicillin 2.4 MU were administered weekly. Post-treatment, the patient's right eye VA improved dramatically to 6/36 over a 4-week period. As syphilis is a curable disease, prompt recognition and management are crucial in achieving a good vision outcome and avoiding lifelong devastating blindness, as reflected in this case.