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Syphilitic Posterior Placoid Chorioretinitis


History of Present Illness

A 62-year-old Caucasian male presents with 3 days of painless vision loss in the left eye (OS).

Past Medical History

Human immunodeficiency virus (HIV) on antiretrovirals

Examination Findings

Exam
OD OS
Visual acuity 20/20 Count fingers
Intraocular pressure 12 13
Pupils 5 mm → 3 mm, no APD 5 mm → 3 mm, no APD
External Normal Normal
Lids/lashes Normal
Conjunctiva/sclera White and quiet White and quiet
Cornea Clear Clear
Anterior chamber Deep and quiet Deep and quiet
Iris Round, reactive, no atrophy, no lesions Round, reactive, no atrophy, no lesions
Lens Mild nuclear sclerosis Mild nuclear sclerosis
Vitreous No vitreous cell/haze No vitreous cell/haze
Dilated Fundus Examination (DFE) See Fig. 41.1A See Fig. 41.1B and C

Fig. 41.1, (A) Color fundus photograph of the right eye shows mild disc edema. (B) Standard color fundus photograph and (C) wide-field photograph demonstrate a large posterior area of chorioretinitis.

Given the disc edema right eye (OD) and chorioretinal lesion OS, fluorescein angiography and optical coherence tomography were pursued ( Figs. 41.2 and 41.3 ).

Fig. 41.2, (A) Fluorescein angiogram of the right eye shows disc leakage. (B) A mid-to-late frame fluorescein angiography (FA) of the left eye shows mild disc leakage and leakage within the macula.

Fig. 41.3, (A) Optical coherence tomography (OCT) of the right eye shows nasal thickening around the nerve. (B) OCT of the left eye shows patchy outer retinal layers and retinal pigment epithelium.

FLOAT NOT FOUND

Questions to Ask

  • Any prior episodes of eye redness, floaters, or loss of vision?

  • Any history of oral or genital ulcerations, joint pain, rashes, gastrointestinal distress, or sexually transmitted disease?

  • Any history of illicit drug use, including intravenous drug use?

  • Have there been any exposures to tuberculosis or at-risk individuals for tuberculosis?

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