Syphilis presenting as acute syphilitic posterior placoid chorioretinitis

• Published in: BMJ case reports 2021-07, Vol.14 (7), p.e243923
• Main Authors: Mehta, Deepesh, Chan, Kenneth
• Format: Article
• Language: English
• Subjects: Acute Disease; Anti-inflammatory agents; Antibiotics; Case reports; Chorioretinitis - diagnosis; Chorioretinitis - drug therapy; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - drug therapy; Fluorescein Angiography; Gays & lesbians; Humans; Images In; Male; Mens health; Middle Aged; Optic nerve; Optics; Syphilis; Syphilis - diagnosis; Syphilis - drug therapy; Tomography, Optical Coherence
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-243923

Correspondence to Dr Deepesh Mehta; [e-mail] Description A 59-year-old man who has sex with men presented to the emergency department with a 1-week history of bilateral central vision loss. Syphilis is a systemic infection secondary to the spirochete Treponema pallidum, of which the incidence is increasing in developed nations, especially in specific groups such as men who have sex with men and intravenous drug users.1 2 Moreover, syphilis can commonly present as a coinfection with HIV.1 2 The manifestations of syphilis are vast and can often masquerade as different systemic and ophthalmological presentations leading to delay of diagnosis and management and potential irreversible visual loss.1 2 ASPPC is a rare manifestation of ocular syphilis, with placoid lesions likely developing secondary to chorioretinal inflammation with outer retinal immune complex deposition, although the exact pathophysiology is not known.1 3 Optical coherence tomography in patients affected by ASPPC is useful in aiding diagnosis and reveals disruption of the outer ellipsoid zone and nodular lesions from the retinal pigmented epithelium (figure 2).2 3 Figure 2. Learning points The incidence of syphilis is increasing especially in groups such as men who have sex with men and intravenous drug users.