Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis
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ORIGINAL PAPER
Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis Eva X. DeVience . Sidney A. Schechet . Marcia Carney . Mona Kaleem . Stephen DeVience . Luke Chang . Michael Gerbo . David M. Hinkle
Received: 16 December 2019 / Accepted: 17 August 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis. Methods This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G. Results In our cohort, the mean age was 47.6 years (range 24–59 years) and 14 patients were male (87.5%), 11 patients were positive for human Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10792-020-01569-0) contains supplementary material, which is available to authorized users. E. X. DeVience (&) University of Maryland Baltimore Washington Medical Center, Baltimore, MD, USA e-mail: [email protected] S. A. Schechet Elman Retina Group, Baltimore, MD, USA M. Carney Eastern Virginia Medical School, Norfolk, VA, USA
immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P \ 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy. Conclusion In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular
S. DeVience Case Western Reserve University, Cleveland, OH, USA L. Chang Department of Ophthalmology Medical College of Georgia Augusta University, Augusta, GA, USA M. Gerbo D. M. Hinkle West Virginia University Eye Institute, Morgantown, WV, USA
M. Kaleem Wilmer Eye Institute, Bethesda, MD, USA
123
Int Ophthalmol
features may help make the diagnosis and monitor treatment response. Keywords Inflammation Retinal vasculitis Syphilis Uveitis Retinitis Chorioretinitis
segmental fashion. These features also respond exquisitely to penicillin therapy, making them useful adjunct in monitoring clinical response. While these clinical presentations are characteristic for ocular syphilis, to the best of our knowledge, this is the first time they have been reported in conjunction in one series.
Introduction Methods Acquired syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum. After a decades
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