Neurosyphilis Manifesting With Bilateral Adie’s Pupil: A Case Report

Background: Pupillary abnormalities play an important role in identification of neurosyphilis. Among them, Argyll Roberston pupil is most typical and has been mentioned in many reports and studies. However, papers about Adie’s pupil associated with neurosyphilis are extremely rare. In the present study, we report a case of patient with bilateral Adie’s pupils as isolated manifestation of neurosyphilis. Case presentation we describe a 58-year-old retired Chinese woman with bilateral Adie’s pupils. Further evaluation revealed serologically positive for Treponema pallidum particle agglutination (TPPA), chemiluminescence immunoassays (CLIA) and rapid plasma regain (RPR) test (1:16). The Cerebrospinal fluid (CSF) examination revealed pleocytosis, elevated protein, and positive RPR (1:2), TPPA and CLIA. Final diagnosis of Adie’s pupils associated with neurosyphilis was made and other possible causes were excluded. Cephalosporin was used for treatment due to penicillin allergy. Despite effective anti-syphilis treatment, her pupils remained unchanged. Conclusions Adie’s pupil can be caused by neurosyphilis and is one of the most important pupillary changes in early neurosyphilis. Our study further underscore the necessity of syphilis screening in patients with Adie’s pupil due to further treatment consideration.