Acute syphilitic posterior placoid chorioretinitis after an intravitreal triamcinolone acetonide injection

Erol, Nazmiye; Topbaş, Seyhan

doi:10.1111/j.1600-0420.2005.00641.x

Cited by 41 publications

(27 citation statements)

References 4 publications

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“…Zamani et al reported another case of ASPPC which presented secondary to immunosuppression following corticosteroid therapy 16 . Furthermore, Erol et al and Song et al published cases of ASPPC following local intravitreal triamcinolone injections suggesting the role of local immunomodulation in the pathogenesis of the disease 17 , 18 . In contrast to the findings of these reports, our patient received corticosteroid and methotrexate for 7 months and demonstrated no worsening of the disease.…”

Section: Discussioncontrasting

confidence: 75%

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

Ormaechea

Hassan

Nguyen

et al. 2019

American Journal of Ophthalmology Case Reports

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PurposeTo report a case of acute syphilitic posterior placoid chorioretinopathy (ASPPC) that demonstrated partial resolution with immunosuppressive therapy secondary to a misdiagnosis as Behçet's disease followed by a relapse which was successfully treated with the appropriate treatment.ObservationsA 34-year-old female patient presented to our service with complaints of decreased vision in the left eye (OS). She initially developed similar symptoms seven months prior to presentation and was diagnosed as Behçet's disease based on the clinical picture of papillitis, vasculitis and placoid chorioretinitis in the posterior pole of OS. She was started on daily oral prednisone 60 mg and weekly methotrexate 10mg by her rheumatologist. The patient's ocular symptoms improved one month prior to presentation with resolution of the placoid lesion but persistence of vasculitis and papillitis. At that time, the dose of the prednisone was decreased to 30 mg which resulted in a relapse of the placoid chorioretinal lesions and worsened visual acuity at the time of presentation to us. Extensive laboratory workup demonstrated positive serology for syphilis. A diagnosis of syphilitic placoid chorioretinitis was made and the patient was treated with intravenous penicillin G for 2 weeks. The vitritis, papillitis, and placoid chorioretinitis resolved along with improvement in vision following the treatment.Conclusions and importanceOcular findings in syphilis are heterogeneous and may mimic variety of ocular diseases. ASPPC is a rare ocular manifestation of syphilis and its natural course and underlying pathophysiology is not well understood. However, irrespective of the underlying mechanism of the disease, all patients with ASPPC should receive treatment to prevent recurrence and long-term functional damage.

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Section: Discussioncontrasting

confidence: 75%

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

Ormaechea

Hassan

Nguyen

et al. 2019

American Journal of Ophthalmology Case Reports

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“…A case of ASPPC after IVTA injection was recently reported [12]. The fundus appearance of the case was essentially identical to those of our patients, after it is taken into account that the fundus in question was the lightly pigmented fundus of a Caucasian subject.…”

Section: Discussionsupporting

confidence: 72%

Acute syphilitic posterior placoid chorioretinitis following intravitreal triamcinolone acetonide injection

Song

Hong

Kwon

2008

Graefes Arch Clin Exp Ophthalmol

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“…The first reported cases were indeed positive for HIV, and later cases were described in patients immediately after corticosteroid treatment which seems to suggest an immune modulation of the disease [3, 5, 7]. Recently, a few cases were reported in immunocompetent individuals [8, 9, 10].…”

Section: Discussionmentioning

confidence: 99%

Spectral-Domain Optical Coherence Tomography Features of Acute Syphilitic Posterior Placoid Chorioretinitis: The Role of Autoimmune Response in Pathogenesis

Brito¹,

Penas²,

Carneiro³

et al. 2011

Case Rep Ophthalmol

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Purpose: Syphilis is an infectious disease that can cause a wide variety of ocular signs. One of the rarest manifestations of ocular syphilis is acute syphilitic posterior placoid chorioretinitis (ASPPC). We report on the spectral-domain optical coherence tomography (SD-OCT) features of a case diagnosed with unilateral ASPPC. Methods: A 64-year-old man presented with a sudden loss of visual acuity (VA) in the right eye. His only clinical sign was a large, geographic, yellow-white lesion centered on the right fovea. Our patient was studied with SD-OCT on presentation and during follow-up, as well as with fluorescein and indocyanine green angiography, electrophysiological study, and serologic and autoimmune screening. Results: Laboratory workup revealed positive serology for active syphilis and elevated anti-beta2 glycoprotein I antibodies. SD-OCT showed a marked distortion of both the choroidal and outer retinal architecture. After treatment, best-corrected VA improved to 20/25. Pattern electroretinography displayed a severe reduction of P50 amplitude, which improved in late follow-up. Six months after presentation, VA was 20/25 and anti-beta2 glycoprotein I antibodies returned to normal levels. Conclusions: Our findings are compatible with immunologically mediated temporary physiological impairment of the neuroretina, since the changes seen by SD-OCT could not have normalized if they were due to anatomical injury. The results of our study provide clues to understanding the pathogenesis of this disease and allow us to define a characteristic temporal sequence of events in ASPPC.

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Acute syphilitic posterior placoid chorioretinitis after an intravitreal triamcinolone acetonide injection

Cited by 41 publications

References 4 publications

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

Acute syphilitic posterior placoid chorioretinopathy: An infectious or autoimmune disease?

Acute syphilitic posterior placoid chorioretinitis following intravitreal triamcinolone acetonide injection

Spectral-Domain Optical Coherence Tomography Features of Acute Syphilitic Posterior Placoid Chorioretinitis: The Role of Autoimmune Response in Pathogenesis

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