{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:36Z","timestamp":1756425816294,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,15]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>A 62-year-old woman presented with non-specific abdominal pain, elevated alkaline phosphatase levels and bilateral sequential visual loss. Visual acuity was counting fingers in right eye (RE) and 20\/400 in left eye (LE). She was noted to have optic nerve pallor in RE and mildly elevated optic disc with signs of ocular inflammation in LE. After 2\u2009weeks, vision deteriorated to light perception bilaterally with now extensive vitreal inflammation present in both eyes. Positive rapid plasma reagen and <jats:italic>Treponema pallidum<\/jats:italic>\u2019s antibody tites confirmed syphilis infection. Unfortunately, as the diagnosis was delayed by many months, her visual acuity remained poor (hand motions in RE and 20\/50 in LE) despite treatment with intravenous penicillin. This case reminds us of the re-emergence of this \u2018great masquerader\u2019 and highlights the importance of maintaining high suspicion for syphilis in patients with unexplained visual loss and systemic symptoms, even in older adults without identifiable risk factors.<\/jats:p>","DOI":"10.1136\/bcr-2021-243847","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T12:23:48Z","timestamp":1625055828000},"page":"e243847","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Older woman with abdominal pain and bilateral sequential vision loss due to syphilis"],"prefix":"10.1136","volume":"14","author":[{"given":"Anna","family":"Kabanovski","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trishal","family":"Jeeva-Patel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Bui","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward A","family":"Margolin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, 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