{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:01:35Z","timestamp":1785391295100,"version":"3.55.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ocular syphilis and neurosyphilis can present as seemingly \u201cisolated\u201d bilateral optic disc edema mimicking papilledema from intracranial hypertension. As a result, patients are often sent to the emergency department (ED) for \u201cpapilledema work-up,\u201d which can lead to delayed or missed ocular syphilis diagnosis since serologic testing for syphilis is not routinely performed in patients with presumed \u201cpapilledema.\u201d Our study describes eight patients initially referred to our ED for \u201cpapilledema\u201d workup who were ultimately diagnosed with ocular syphilis based on characteristic findings seen on non-mydriatic ocular fundus photography and optical coherence tomography nerve\/macula (NMFP-OCT) obtained in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the ocular imaging findings seen on non-mydriatic ocular fundus photography and optical coherence tomography (NMFP-OCT) in the ED and clinical outcomes of patients with ocular syphilis who presented to the ED with presumed \u201cpapilledema\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Descriptive case series study involving prospective collection of all consecutive adult patients presenting to our general ED between 6\/14\/2023 to 9\/21\/2025 for \u201cpapilledema work-up,\u201d who were subsequently diagnosed with ocular syphilis. Clinical findings on NMFP-OCT were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 6\/14\/2023 to 9\/21\/2025, 8\/318 patients (2.5%) who underwent our \u201cpapilledema protocol\u201d were ultimately diagnosed with ocular syphilis. All 8 patients had bilateral optic disc edema on ocular imaging, triggering our \u201cpapilledema protocol\u201d in the ED. Visual acuities ranged from 20\/20 to hand motion. 5\/8 (63%) patients had outer retinal abnormalities and 7\/8 (88%) had vitreous cells, which were remotely identified on NMFP-OCT imaging obtained in the ED by ED staff. 7\/8 (88%) patients underwent attempted lumbar puncture (LP), but LP was unsuccessful in 1\/7 patients. 5\/6 (83%) patients with LP performed in the ED had normal CSF-opening pressure; 4\/6 (67%) had elevated CSF nucleated cells [range 7\u201324]; 3\/6 (50%) patients had reactive CSF VDRL. All patients had serologic positive RPR\/syphilis IgG-IgM. All patients received 14\u202fdays of IV penicillin G. 4\/8 (50%) patients were lost to follow-up. Among patients who were seen in outpatient follow-up, ranging from 2\u202fweeks to 8\u202fmonths after initial presentation, all were found to have improving or resolution of disc edema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Syphilis may present as seemingly \u201cisolated\u201d bilateral disc edema in the ED. Remote interpretation of NMFP-OCT obtained in the ED allowed for detection of subtle outer retinal changes and vitreous cells, heightening suspicion for ocular syphilis and triggering confirmatory serologic testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1881880","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:39:48Z","timestamp":1785389988000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The use of non-mydriatic ocular fundus imaging in the emergency department for detection of ocular syphilis presenting as presumed \u201cpapilledema\u201d: a case series"],"prefix":"10.3389","volume":"17","author":[{"given":"Wei-Hsuan","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Emory University School of Medicine","place":["Atlanta, GA, United 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States"]},{"name":"Department of Neurology, Emory University School of Medicine","place":["Atlanta, GA, United States"]},{"name":"Department of Neurological Surgery, Emory University School of Medicine","place":["Atlanta, GA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Biousse","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Emory University School of Medicine","place":["Atlanta, GA, United States"]},{"name":"Department of Neurology, Emory University School of Medicine","place":["Atlanta, GA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1001\/jama.2025.17362","article-title":"Syphilis: a 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