Syphilitic Neuroretinitis with Positive Cytomegalovirus Serology in an Immunocompetent Adolescent: A Case Report.

INTRODUCTION: Neuroretinitis is an inflammatory optic neuropathy characterized by optic disc edema followed by macular star formation. It is most commonly caused by Bartonella henselae, but other infectious etiologies including syphilis and cytomegalovirus (CMV) should be considered, particularly due to their potential for severe visual morbidity if untreated. CASE PRESENTATION: A 17-year-old immunocompetent female presented with unilateral visual blurring and headache. Ophthalmologic examination revealed optic disc edema, macular star exudates, and peripapillary hemorrhages in the right eye. Dermatologic examination revealed features consistent with secondary syphilis, and the diagnosis was further supported by laboratory investigations confirming syphilis. Serologic testing also demonstrated positive CMV IgM and IgG antibodies. HIV testing was negative. The patient was treated with intravenous ceftriaxone and ganciclovir followed by oral valganciclovir. Complete anatomical and functional recovery was achieved with restoration of visual acuity. CONCLUSION: This case highlights the importance of comprehensive infectious evaluation in neuroretinitis, even in immunocompetent individuals. Early diagnosis and appropriate targeted antimicrobial therapy are essential to prevent permanent visual loss.