Acute Syphilitic Posterior Placoid Chorioretinitis; a Case Report and Review

Abstract

Background: Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is a rare but defining characteristic of ocular syphilis. Clinical findings are subtle, geographic, yellowish, macular lesions, affecting the outer-retina and inner choroid, and often associated with subretinal fluid in the early phase. This case report will review the clinical signs of ASPPC to aid the practitioner in identification and recognition of its clinical importance as it relates to early diagnosis, treatment, and prognosis. Case Report: A 79-year-old African American male presented to clinic with a chief complaint of blur in the right eye for the prior two days. Spectral Domain Optical Coherence Tomography (SD-OCT) of the macula revealed a shallow retinal pigment epithelial detachment with subretinal fluid centrally with some loss of the retinal pigment epithelium (RPE) and photoreceptors nasally in the right eye. There was rapid progression over a week to full loss of RPE and photoreceptors with reduction of vision to hand motion in the right eye, suggesting an infectious etiology. Serologic testing was ordered, and an RPR and FTA-ABS were both reactive. A diagnosis of acute syphilitic posterior placoid chorioretinopathy was made. An infectious disease physician treated the patient with IV penicillin G. There was a complete resolution of ocular findings. Conclusion: Syphilis should be considered for any ocular inflammatory condition. ASPPC is highly suggestive of syphilis. All patients with ocular syphilis should be evaluated for neurosyphilis. Treatment is IV penicillin G for 10-14 days and considered successful when there is a four-fold reduction in titers. Full visual recovery typically occurs within 12 weeks of treatment if a diagnosis and treatment are initiated early in the course of ocular disease.