Dilated tonic pupils with tabes dorsalis in neurosyphilis as first manifestation of HIV/AIDS: a video report

Description

A previously healthy 30-year-old bisexual African man was admitted with a 3-month history of weight loss, paroxysmal shooting pains and paraesthesia of both lower limbs and difficulty in walking. He denied progression of visual symptoms such as blurred vision with reading and near work, photophobia, anisocoria or visual loss. The Mini-Mental State Examination was normal (30/30). He was alert, oriented to time, person and place with a Glasgow Coma Scale of 15/15. His body mass index was 17 kg/m². There was generalised wasting syndrome, cervical lymphadenopathy and diffuse hair loss of the scalp and eyebrows. There was no urinary incontinence.

Visual acuity without correction (20/20), visual fields, intraocular pressures (14 mm Hg) and fundoscopy were normal in both eyes. Ocular motility was full bilaterally with no nystagmus. The pupils, however, were 6.0 mm in diameter on room light bilaterally, unreactive to light or accommodation (Video 1, segment 1)....

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