Diffuse Bilateral Subacute Placoid Chorioretinitis and Hot Optic Disc as Part of Ocular Manifestations of Neurosyphilis: A Case Report

Background

Syphilis is a chronic infectious disease caused by a spirochaete bacterium named Treponema pallidum. The disease is generally transmitted by sexual contact, from mother to infant, and also by blood transfusion. Treponema pallidum, if untreated, is able to survive in the human host for decades [1]. Many different ocular presentations of congenital and acquired syphilis have long been described. In the past years, attention has been paid to a clinical presentation resembling acute retinal necrosis, predominantly seen in homosexual and heterosexual men [2], [3], [4]. In acquired syphilis, some clinical presentations, among which include the presence of panuveitis, vitreous cell inflammation, and/or non-elevated placoid lesions, should, however, raise the suspicion of syphilis. Delay in diagnosis of chorioretinitis spreading to the macula, considered to be a rare but clinically distinct complication, might be associated with visual loss and thus require prompt therapy.

Herein, we report on a case of posterior placoid chorioretinitis with papillitis, as a rare re-emerging ocular manifestation of syphilis.

Publication History

Received: 23 September 2020

Accepted: 28 December 2020

Article published online:
30 April 2021

• References

• 1 Rassner G. Dermatologie. 9. Aufl.. München: Elsevier; 2009
• 2 Hussnain SA, Ketner S, Coady PA. et al. Ocular Syphilis Presenting as Bilateral Acute Retinal Necrosis in an Immunocompetent Host. Conn Med 2016; 80: 533-536
• 3 Balansard B, Bodaghi B, Cassoux N. et al. Necrotising retinopathies simulating acute retinal necrosis syndrome. Br J Ophthalmol 2005; 89: 96-101 doi:10.1136/bjo.2004.042226
• 4 Kuo A, Ziaee SM, Hosseini H. et al. The Great Imitator: Ocular Syphilis Presenting as Posterior Uveitis. Am J Case Rep 2015; 16: 434-437 doi:10.12659/AJCR.893907
• 5 Centers For Disease Control and Prevention. Syphilis. Accessed December 1, 2020 at: https://www.cdc.gov/std/stats17/syphilis.htm
• 6 Bowling B. Kanskiʼs Clinical Ophthalmology. 8th ed. Print Book & E-Book. China: Elsevier; 2016
• 7 Gass JD, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis. Ophthalmology 1990; 97: 1288-1297 doi:10.1016/s0161-6420(90)32418-1
• 8 Park JH, Joe SG, Yoon YH. Delayed diagnosis of ocular syphilis that manifested as retinal vasculitis and acute posterior multifocal placoid epitheliopathy. Indian J Ophthalmol 2013; 61: 676-678 doi:10.4103/0301-4738.119415
• 9 Dutta Majumder P, Biswas J, Gupta A. Enigma of serpiginous choroiditis. Indian J Ophthalmol 2019; 67: 325-333 doi:10.4103/ijo.IJO_822_18
• 10 Ormaechea MS, Hassan M, Nguyen QD. et al. Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?. Am J Ophthalmol Case Rep 2019; 14: 70-73 doi:10.1016/j.ajoc.2019.03.002
• 11 Eandi CM, Neri P, Adelman RA. et al. Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature. Retina 2012; 32: 1915-1941 doi:10.1097/IAE.0b013e31825f3851