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Yujeong Kim, Yong Un Shin, Byung Ro Lee, Heeyoon Cho, Han Woong Lim; Multidisciplinary imaging of acute syphilitic posterior placoid chorioretinitis: penicillin-treated cases versus penicillin-untreated cases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):280.
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To describe ophthalmic findings of acute syphilitic posterior placoid chorioretinitis (ASPPC) using the multidisciplinary imaging and compare the image findings between penicillin-treated cases and penicillin-untreated cases
: All four patients were diagnosed as ASPPC by using multidisciplinary imaging techniques such as fluorescein angiography (FA), indocyanine green angiography (IA), spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). At initial visit, all patients showed similar imaging findings. FA revealed irregular late-staining hyperfluorescence of the placoid lesion and diffuse staining of the optic disc and retinal vessels. A revealed early multiple scattered hypofluorescent spots in the lesion and a well-demarcated area of hypofluorescence corresponding to the placoid lesion in late phase. SD-OCT revealed an ill-defined photoreceptor inner/outer segment(IS/OS) junction and absent external limiting membrane(ELM), thickening and granular hyperreflectivity of the retinal pigment epithelium(RPE). FAF images showed central hyperautofluorescence corresponding to the area of the placoid lesion.
Two patients were treated with intravenous penicillin G and oral prednisolone immediately after the diagnosis, while other two patients were treated with only oral prednisolone due to late diagnosis and follow-up loss. Penicillin-treated cases showed prompt visual recovery and normalization of all imaging findings, while penicillin-untreated cases showed partial visual recovery and abnormal image findings were still remained.
Our multimodal imaging findings are similar to multiple evanescent white dot syndrome (MEWDS) involving outer retina mainly, which may provide clues for understanding of the pathogenesis of ASPPC. Also we identified that ASPPC should be treated with intravenous penicillin to achieve complete imaging restoration.
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