Korean J Ophthalmol.  2009 Jun;23(2):108-111. 10.3341/kjo.2009.23.2.108.

Atypical Acute Syphilitic Posterior Placoid Chorioretinitis

• Yoo C
• Kim SK
• Huh K
• Oh J

• KMID: 754727
• DOI: http://doi.org/10.3341/kjo.2009.23.2.108

Abstract

A 48-year-old man presented with visual dimness in the right eye that had developed 2 weeks previously. Dilated fundus examination showed few vitreous cells and numerous yellow, placoid lesions in both eyes. His right eye had more severe serous retinal detachment involving the macula. Fluorescein angiography demonstrated early irregular hypofluorescence with late staining in the areas of the yellow placoid lesions. He started a regimen of 60 mg of oral prednisone daily. Two weeks later, a serologic fluorescent treponemal antigen absorption test was positive for Ig G and Ig M. He was referred to an infectious disease specialist for antibiotic therapy. A week later, he returned, having stayed on prednisone only and not having taken the internist's antibiotic prescription. Meanwhile, the chorioretinitis in his right eye, which had initially been at a more advanced stage, was resolved with the use of steroids. The chorioretinitis in his left eye, which was aggravated at an earlier stage, ultimately recovered. Our case had atypical courses such that one eye improved and the other worsened during the same steroid treatment period. This result was inconsistent with that of previous reports showing that oral steroid influences the clinical course of acute syphilitic posterior placoid chorioretinitis.

Keyword

Chorioretinitis; Posterior placoid chorioretinitis; Steroid; Syphilis

MeSH Terms

Acute Disease
Anti-Bacterial Agents/administration & dosage
Ceftriaxone/administration & dosage
Chorioretinitis/diagnosis/drug therapy/*microbiology
Diagnosis, Differential
Eye Infections, Bacterial/diagnosis/drug therapy/*microbiology
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Injections, Intravenous
Male
Middle Aged
Syphilis/diagnosis/drug therapy/*microbiology

Figure

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  Fig. 1 (A, B) At initial presentation, numerous yellow, placoid lesions were noted in both eyes. Serous retinal detachment involving only the macula in the patient's right eye was observed. (C, D) Two weeks after treatment with prednisone, lesions of the right eye completely resolved. However, macular edema in the left eye increased.

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  Fig. 2 At initial presentation, fluorescein angiography demonstrated early irregular hypofluorescence with late staining in the areas of the yellow placoid lesions.

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