Título

POSTERIOR PLACOID SYPHILITIC CHORIORETINITIS: A CASE REPORT

Objetivo

To present the OCT findings as tools for the diagnosis of atypical cases of ocular syphilis

Relato do Caso

31 years old caucasian male, with prior diagnosis of C3 AIDS and psoriasis, in current HAART treatment, presenting progressive and painless reduction of visual acuity in his right eye in the last 10 days which had come along with hiperemic, flat, plaquelike, skin lesions on the upper trunk and limbs which were previously defined as being part of a psoriatic manifestation. He was referred our service with the diagnosis of acute anterior, non granulomatous, uveitis in his right eye, treated with prednisolone acetate and tropicamide, showing no response and, at that point, worsening of visual acuity in his left eye. Ophthalmic examination demonstrated BCVA of hand motion in his right eye and 0,2 Snellen chart in his left eye. Biomicroscopy revealed ACR+/4 in OD and ++/4 in OS with fine KPs. IOP 12 mmHg in both eyes. Ophthalmoscopy showed clear media with flat, yellowish, placoid lesion involving the macular area, papillo-macular bundle and peri papillary area bilaterally.  Angiography showed progressive hyperfluorescence throughout macular and peripapillary area defining the extension of the lesion with no leakage. OCT revealed a hyperreflective infiltrate along the RPE and points of disrruption of the IS/OS line as well as signs of edema in the peri-papillary area.    Differential diagnosis was set with neoplasic infiltration, AMMPE and infectious neuro-retinitis.  Lab work-up showed TPHA reactive and VDRL 1/128; CD4=100. CSF was clear for Syphilis. Final diagnosis was Acute Posterior Placoid Syphilitic Chorioretinitis and treatment was conducted with Ceftriaxone 2g/day for 14 days with gradative  improvement of visual acuity, fundus, OCT status and a complete resolution of the skin lesions which defined the clinical diagnosis of secondary syphilis.

Conclusão

The incidence of syphilis has been increasing in our country, which makes its study very relevant. Atypical presentations should always be part of the differential diagnosis of patients with uveitis.