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    General

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    Grand Rounds

    A patient with past medical history of VZV stromal keratitis presented to the Bascom Palmer Emergency Room with one week of bilateral blurry vision. Visual acuity was 20/200 in the right eye and 20/80 in the left. On slit lamp examination, anterior segment revealed bilateral vitreous cell. Fundus exam showed bilateral white subretinal lesions in the macula and mid-periphery. Fundus autofluorescence showed macular hyper-autofluorescence correlating with the area of placoid retinal lesions. OCT revealed marked disruption of the outer retinal layers bilaterally. Laboratory testing revealed a positive RPR titer (1:512) and HIV reactive antigen-antibody test. A diagnosis of acute syphilitic posterior placoid chorioretinitis was made and treatment with IV penicillin x 14 days was initiated. Patient was also started on antiretroviral therapy for HIV. Patient’s retinal lesions and symptoms had resolved one month after follow-up. After a year, patient demonstrated a visual acuity of 20/20 in both eyes. OCT changes had resolved by this point and returned to baseline.

    Presentation Date: 10/29/2026
    Issue Date: 10/30/2026

    • Presenter: Anshul Bhatnagar, MD URL
    • Faculty Discussant: Nicolas A. Yannuzzi, MD URL

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