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A 35-year-old patient presented with a two-month history of progressive bilateral blurry vision and a rash on the trunk that developed two weeks before presentation. He was not taking any medications. The patient had a few days of flulike symptoms about four months earlier.
On examination, the patient appeared healthy and was in no distress. His visual acuity was 20/30 in each eye without a relative afferent pupillary defect. Ophthalmoscopy demonstrated bilateral asymmetric optic nerve head swelling and scattered tiny white spots in the retinas (Figure 1). There was an erythematous, maculopapular eruption on the trunk and left arm (Figure 2).
FIGURE 1[Figure omitted. See PDF]
FIGURE 2[Figure omitted. See PDF]
Question
Based on the patient's history, physical examination, and test findings, which one of the following is the most likely diagnosis?
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A. Idiopathic intracranial hypertension.
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B. Malignant hypertension.
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C. Optic neuritis.
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D. Secondary syphilis.
Discussion
The answer is D: secondary syphilis. Secondary syphilis often involves the eye and can cause optic nerve...