This patient has classic findings for acute placoid syphilis in the right eye.
The fundus photo demonstrates an orange-yellow subretinal lesion. OCT shows attenuation of the outer retinal layers (including the ellipsoid zone) and a thickening of the RPE.
Angiographically, this inflammatory lesion blocks early and stains late. The patient was referred to the infectious disease specialist for parenteral antibiotics.
Learning Points:
In internal medicine, syphilis has been called “the great imitator” since it can masquerade as so many systemic disorders. The ocular manifestations are legion as well.
Originally described by Gass (Ophthalmology 1990;97;1288-1297), placoid syphilis affects the outer retina, RPE, and choriocapillaris and clinically manifests as an orange-yellow subretinal lesion.
Placoid syphilis has a fairly good visual prognosis with treatment. Patients also need to be evaluated for HIV since syphilis and HIV infections often coexist.
