Atlas of Ophthalmology

Acute Syphilitic Posterior Placoid Chorioretinopathy in Reactivated Syphilis (Colour Photography Posterior Segment, FFA, SD-OCT)

Retina -> Infections (see Systemic Diseases)
Patient:76 years of age, male, BCVA 0.7 at OD, 0.6 at OS. Ocular Medical History: blurry vision at OS since 3 years. General Medical History: TPHA tests (TPPA IPAT) in serum positive (Titer <1:80), human immunodeficiency virus test negative, no evidence of neurosyphilis. Purose: to present acute syphilitic posterior placoid chorioretinitis (ASPPC) in an immunocompetent 76-year-old man as reactivated syphilis. Methods: Colour Photography Posterior Segment, FFA, SD-OCT. Findings: Colour Photography Posterior Segment: large, yellowish, placoid, outer retinal lesion. FFA: small focal hyperfluorescence in the area of the hypofluorescent lesion, peripheral multifocal choroiditis with multifocal leakages, diffuse late macular edema, papillary leakage, SD-OCT: cystoid macular edema, epiretinal gliosis. small amount of subretinal fluid. Discussion: Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare manifestation of syphilis. (1-3) Fundus and angiographic changes in ASPPC may mimic other chorioretinal diseases, including acute posterior multifocal placoid pigmentepitheliopathy (APMPPE). It was suggested that inflammation-associated perfusion abnormalities of the choriocapillaris contribute to the pathophysiological process. Most cases respond to systemic treatment of the underlying Treponema pallidum infection. Literature: Eandi CM, Neri P, Adelman RA, Yannuzzi LA, Cunningham ET Jr; International Syphilis Study Group. Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature. Retina.2012 Oct;32(9):1915-41. Bellmann C Holz FG, Breitbart A, Völcker HE. Bilateral acute syphilitic posterior placoid chorioretinopathy--angiographic and autofluorescence characteristics. Ophthalmologe.. 1999 Aug;96(8):522-8 Szepessy Z, Entz BB, Nagy ZZ. Atypical acute syphilitic posterior placoid chorioretinitis. Ophthalmologe. 2016 Jul 26.

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