Skip to main content

Advertisement

SpringerLink
Log in

Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis.

Methods

This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G.

Results

In our cohort, the mean age was 47.6 years (range 24–59 years) and 14 patients were male (87.5%), 11 patients were positive for human immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P < 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy.

Conclusion

In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular features may help make the diagnosis and monitor treatment response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention (CDC).

  2. https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm (Accessed November 1st, 2019)

  3. Eandi CM, Neri P, Adelman RA et al (2012) Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature. Retina 32(9):1915–1941

    Article  Google Scholar 

  4. Chao JR, Khurana RN, Fawzi AA, Reddy HS, Rao NA (2006) Syphilis: reemergence of an old adversary. Ophthalmology 13(11):2074–2079

    Article  Google Scholar 

  5. Wickremasinghe S, Ling C, Stawell R et al (2009) Syphilitic punctate inner retinitis in immunocompetent gay men. Ophthalmology 116(6):1195–1200

    Article  Google Scholar 

  6. Fu EX, Geraets RL, Dodds EM, Echandi L et al (2010) Superficial retinal precipitates in patients with syphilitic retinitis. Retina 30(7):1135–1143

    Article  Google Scholar 

  7. Pichi F, Ciardella AP, Cunningham ET, Morara M, Veronese C, Jumper JM et al (2014) Spectral domain optical coherence tomography findings in patients with acute syphilitic posterior placoid chorioretinopathy. Retina 34(2):373–384

    Article  Google Scholar 

  8. Northey LC, Skalicky SE, Gurbaxani A, McCluskey PJ (2015) Syphilitic uveitis and optic neuritis in Sydney, Australia. Br J Ophthalmol 99(9):1215–1219

    Article  Google Scholar 

  9. Furtado JM, Arantes TE, Nascimento H et al (2018) Clinical manifestations and ophthalmic outcomes of ocular syphilis at a time of re-emergence of the systemic infection. Sci Rep 8(1):12071

    Article  Google Scholar 

  10. Amaratunge BC, Camuglia JE, Hall AJ (2010) Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients. Clin Exp Ophthalmol 38(1):68–74

    Article  Google Scholar 

  11. Moradi A, Salek S, Daniel E et al (2015) Clinical features and incidence rates of ocular complications in patients with ocular syphilis. Am J Ophthalmol 159(2):334–343.e331

    Article  Google Scholar 

  12. Dick AD, Tundia N, Sorg R et al (2016) Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology 123(3):655–662

    Article  Google Scholar 

  13. Neri P, Azuara-Blanco A, Forrester JV (2004) Incidence of glaucome in patients with uveitis. J Glaucoma 13(6):461–465

    Article  Google Scholar 

  14. Fathilah J, Choo MM (2003) The Jarisch–Herxheimer reaction in ocular syphilis. Med J Malaysia 58(3):437–439

    CAS  PubMed  Google Scholar 

  15. Benson CE, Soliman MK, Knezevic A et al (2015) Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis. J Ophthalmic Inflamm Infect 5(5):16

    Article  Google Scholar 

  16. Chang L, Mi C, et al. (2015) American Medical Student Research Journal;1 (2):126–31

  17. Pichi F, Neri P (2020) Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment. Int Ophthalmol 40(5):1319–1329. https://doi.org/10.1007/s10792-020-01285-9

    Article  PubMed  Google Scholar 

  18. Cunningham ET Jr, Eandi CM, Pichi F (2014) Syphilitic uveitis. Ocul Immunol Inflamm 22(1):2–3

    Article  Google Scholar 

  19. Oliver GF, Stathis RM, Furtado JM et al (2019) Current ophthalmology practice patterns for syphilitic uveitis. Br J Ophthalmol 103(11):1645–1649. https://doi.org/10.1136/bjophthalmol-2018-313207

    Article  PubMed  Google Scholar 

  20. Russell JF, Pichi F, Scott NL et al (2020) Masqueraders of multiple evanescent white dot syndrome (MEWDS). Int Ophthalmol 40(3):627–638. https://doi.org/10.1007/s10792-019-01223-4

    Article  PubMed  Google Scholar 

  21. Balaskas K, Spencer S, D’Souza Y (2013) Peripapillary choroidal neovascularisation in the context of ocular syphilis is sensitive to combination antibiotic and corticosteroid treatment. Int Ophthalmol 33:159–162. https://doi.org/10.1007/s10792-012-9641-2

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by American Glaucoma Society (2019 MAPS Research Grant).

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. University of Maryland Baltimore Washington Medical Center, Baltimore, MD, USA

    Eva X. DeVience

  2. Elman Retina Group, Baltimore, MD, USA

    Sidney A. Schechet

  3. Eastern Virginia Medical School, Norfolk, VA, USA

    Marcia Carney

  4. Wilmer Eye Institute, Bethesda, MD, USA

    Mona Kaleem

  5. Case Western Reserve University, Cleveland, OH, USA

    Stephen DeVience

  6. Department of Ophthalmology Medical College of Georgia Augusta University, Augusta, GA, USA

    Luke Chang

  7. West Virginia University Eye Institute, Morgantown, WV, USA

    Michael Gerbo & David M. Hinkle

Authors
  1. Eva X. DeVience
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sidney A. Schechet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcia Carney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mona Kaleem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen DeVience
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luke Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Gerbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David M. Hinkle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva X. DeVience.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Due to the retrospective nature of this work, informed consent was waived by Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10792_2020_1569_MOESM1_ESM.tif

Supplemental Figure 4 Optic disc photographs in patient 5. Improvement of severe papillitis from presentation (3a) to one week (3b), and resolution to optic atrophy at 8 months after presentation (3c) (TIF 960 kb)

10792_2020_1569_MOESM2_ESM.tif

Supplemental Figure 5 Anterior slit lamp photographs in patient 3. There is severe anterior uveitis with a red-streaked hypopyon (TIF 2240 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DeVience, E.X., Schechet, S.A., Carney, M. et al. Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis. Int Ophthalmol 41, 211–219 (2021). https://doi.org/10.1007/s10792-020-01569-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-020-01569-0

Keywords

Search

Navigation