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

Abstract

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.

Acute syphilitic posterior placoid chorioretinitis in a Saudi patient

“…Delaying in the treatment may lead to permanent functional damage. [ 11 ] In our patient, the early recognition and initiation of anti-syphilitic treatment resulted in rapid anatomical and visual recovery.…”

Spontaneous resolution of acute syphilitic posterior placoid chorioretinitis: reappraisal of the literature and pathogenetic insights

“…Furthermore, Erol et al [ 18 ] and Song et al [ 19 ] published cases of ASPPC following local intravitreal triamcinolone injections. However, in contrast to these aforementioned cases [ 17 ], [ 18 ], [ 19 ], Ormaechea et al [ 20 ] reported a patient with ASPPC who was initially misdiagnosed as having non-infectious uveitis and received corticosteroid as well as methotrexate for 7 months and demonstrated no worsening of the disease.…”

Acute syphilitic posterior placoid chorioretinopathy: a case report

“…7 In one published report, it was reported that auto-immunity plays a significant role in this form of syphilitic uveitis. 8 Diagnosis of syphilis mainly depends on serology and clinical manifestations. Initial screening is done by VDRL and rapid plasma regain (RPR) tests, which should further be confirmed by Treponemal tests (FTA, chemiluminescent micro-particle immunoassay (CMIA) and Treponema pallidum particle agglutination assay (TP-PA) if needed.…”

“…3 Similarly, another case report described the possible role of corticosteroids in slowing the progress of acute syphilitic posterior placoid chorioretinopathy; however, complete remission is not possible without antibiotic. 8 Another treatment option is intramuscular injection of procaine penicillin G one per day along with four times oral probenecid 500 milligrams daily. This regime should continue for 10 to 14 days.…”