An adult patient presented to the Bascom Palmer emergency room for evaluation of five days of bilateral painless vision loss and floaters. On slit lamp examination he did not have any conjunctival injection or anterior chamber cell or flare. Dilated fundus examination demonstrated vitreous cell and optic disc edema bilaterally, as well as yellow-white placoid lesion in the posterior pole of both eyes. Macula OCT revealed loss of the ellipsoid zone, granular nodularity of the retinal pigment epithelium, and hyper-reflectivity of the inner choroid bilaterally. The placoid lesions were progressively hyperfluorescent on fluorescein angiography. The patient was admitted to the nearby medical hospital with concern for ocular syphilis and infectious disease consultation. Serum testing revealed a positive rapid plasma reagin test (RPR) with a titer of 1:1024, Cerebral spinal fluid analysis demonstrated a positive Venereal Disease Research Laboratory (VDRL) test with a titer of 1:2. HIV, tuberculosis, and sarcoidosis laboratory evaluation was negative. The patient was diagnosed with acute syphilitic posterior placoid chorioretinitis. The patient was started on 14 days of intravenous penicillin by the infectious disease team. On follow-up in the ophthalmology clinic, his vision returned to baseline and the placoid chorioretinal lesions of fundus examination resolved.
Presentation Date: 08/25/2022
Issue Date: 09/02/2022