Multimodal Imaging Analysis of Acute Syphilitic Posterior Placoid Chorioretinitis: A Case Report

Abstract

The authors report a multimodal imaging analysis of a case of acute syphilitic posterior placoid chorioretinitis (ASPPC) occurring in a 51-year-old man. Best-corrected visual acuity (BCVA) was 0.5 and 0.8 in the right and left eyes, respectively. The authors performed spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. All of the examinations were suggestive of the diagnosis of ASPPC, a rare manifestation of syphilis that has distinctive anatomical characteristics that are detectable early on with multimodal imaging. Moreover, serological tests were positive for syphilis infection, so the patient received intravenous penicillin G for 14 days. Final BCVA was 1.0 in the right eye and 0.9 in the left eye. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:e179–e184.]

The Eye as a Window to Systemic Infectious Diseases: Old Enemies, New Imaging

“…Acute syphilitic posterior placoid chorioretinitis (ASPCC) is a rare ocular manifestation of secondary syphilis. First described by Gass et al [29], it is characterized by the development of a large, deep, yellowish circular or oval placoid lesion at the posterior pole localized in the outer retinal layers (ORLs) that rarely extends beyond vascular arcades [30]. Its pathogenesis is probably linked to Treponema pallidum direct invasion of the choriocapillaris with consequent vascular obstruction or deposition of soluble immune complexes [29].…”

“…Fluorescein angiography (FA) reveals early hypofluorescence and late hyperfluorescence at the posterior pole corresponding to the lesions. Indocyanine green angiography (ICGA) shows hypocyanescence until the late stages of the examination [30,34].…”