Spectral optical coherence tomography findings in an adult patient with syphilitic bilateral posterior uveitis and unilateral punctate inner retinitis

Abstract

Purpose To describe the spectral domain optical coherence tomography (SD-OCT) features of a punctate inner retinitis, a rare ocular manifestation of syphilis, in an HIV positive adult patient. Observations In the right eye, SD-OCT images during the active period showed hyperreflectivity of the full thickness of the inner retina, precluding the individualization of the layers. In addition, multifocal areas with higher hyperreflectivity were identified within the affected retina. Once the lesion became inactive, SD-OCT images revealed inner retina layers atrophy, disruption of the ellipsoid layer, and multifocal damage to the retinal pigment epithelium layer. Conclusion and importance Punctate inner retinitis affects the full thickness retina, leading to severe retinal damage, along with multifocal damage of the retinal pigment epithelium. The multifocal white retinal lesions observed within the affected retinal area correlated with the presence of intense hyperreflective dots within the retina showed by SD-OCT. These lesions are deeper than was described in other reports.

Case Report: Bilateral Choroidal Neovascular Membranes in a Patient With a Delayed Diagnosis of Acute Syphilitic Posterior Placoid Chorioretinopathy

“…Typical OCT findings in ASPPC include disruption of the external limiting membrane, nodular elevation of the OS/RPE junction and hyperreflectivity of the RPE (3,7). While not present in our patient, the presence of inner retinal precipitates on fundus examination and SD-OCT imaging is also highly suggestive of syphilitic retinitis (12,13).…”

Syphilitic Uveitis With Diverse Clinical Presentations: Multimodal Imaging as a Useful Adjunctive Tool for Diagnosis and Treatment

“…Diagnosis of syphilis is often challenging, and delay in appropriate antibiotic treatment can lead to poor visual prognosis [ 5 ]. It is not uncommon for patients to be misdiagnosed with noninfectious uveitis and initiated on steroid therapy, leading to temporary symptomatic improvement, which may worsen during steroid titration or termination [ 4 , 8 - 9 ]. According to Parthopratim, the frequency of syphilitic uveitis by location is as follows: anterior uveitis: 10%, posterior uveitis: 13%, optic neuritis: 22%, panuveitis: 41%, and vitreous inflammation: 65% [ 5 ].…”

Ocular Syphilis with Retinal and Disc Neovascularization Treated with Bevacizumab: A Case Report

“…Ocular syphilis has a wide range of clinical manifestations. It may be unilateral or bilateral, and it can involve anterior, intermediate, or posterior segments [ 8 ]. Different case series have shown disparate predominant types of syphilitic uveitis [ 1 , 9 , 10 ].…”