Bilateral acute syphilitic posterior placoid chorioretinopathy - angiographic and autofluorescence characteristics

Acute syphilitic posterior placoid chorioretinitis (ASPPC) has been describ ed as a rare chorioretinal manifestation in patients with secondary syphili s. The fundus changes may simulate other chorioretinal disorders and thus d elay an accurate diagnosis and initiation of appropriate pharmacological th erapy. Patient: A 54-year-old male patient presented with severely impaired visual acuity in both eyes. Yellowish geographic lesions were noted at the poster ior pole. Scanning laser ophthalmoscopy showed corresponding areas of incre ased fundus autofluorescence. On fluorescein angiography hypofluorescent le sions were noted in the early phase, which became hyperfluorescent in later frames. Indocyanine green agiography demonstrated hypofluorescent lesions both during the early and late frames. Serological examinations were positi ve for secondary lues (TPHA, FTA-IgM, cardiolipin antibody). Treatment with penicillin was introduced, resulting in complete functional and morphologi cal recovery. Conclusion: Fundus and angiographic changes in ASPPC may mimic other chorio retinal diseases, including acute posterior multifocal placoid pigmentepith eliopathy (APMPPE). The angiographic findings suggest that inflammation-ass ociated perfusion abnormalities of the choriocapillaris contribute to the p athophysiological process. Accurate diagnosis of ASPPC as a presenting sign of secondary lues is especially important for the prompt initiation of sys temic antibiotic treatment.