ABSTRACT
Purpose: To report two cases of syphilitic outer retinopathy that showed diffuse phlebitis on fluorescein angiography (FA).Methods: Retrospective chart review.Results: The two patients had presentation similar to acute zonal occult outer retinopathy (AZOOR), including hyperautofluorescence on fundus autofluorescence and ellipsoid zone disruption on optical coherence tomography. The main difference from AZOOR was the finding of diffuse phlebitis on FA. Both patients recovered well after antibiotic and steroid treatment.Conclusion: FA is especially important for differentiating syphilitic outer retinopathy from AZOOR. Timely diagnosis and treatment with penicillin and cautious use of steroid usually lead to favorable prognosis.
Subject(s)
Eye Infections, Bacterial/diagnosis , Phlebitis/diagnosis , Retinal Vein/pathology , Scotoma/diagnosis , Syphilis/diagnosis , White Dot Syndromes/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Doxycycline/therapeutic use , Electroretinography , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Female , Fluorescein Angiography , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Phlebitis/drug therapy , Phlebitis/microbiology , Prednisolone/therapeutic use , Retrospective Studies , Scotoma/drug therapy , Scotoma/microbiology , Syphilis/drug therapy , Syphilis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Field Tests , Visual Fields/physiology , White Dot Syndromes/drug therapy , White Dot Syndromes/microbiologyABSTRACT
BACKGROUND: This paper reports the case of a young man who presented with syphilis masquerading as multiple evanescent white dots syndrome (MEWDS), which turned out to be an acute syphilitic posterior placoid chorioretinopathy (ASPPC) during follow-up. CASE PRESENTATION: A 59-year-old healthy male consulted for a three days' history of visual impairment in both eyes. On multimodal imaging, he was diagnosed as MEWDS. Fundus fluorescein angiography (FFA) showed early peripheral bilateral granular hyperfluorescence that correlated with the yellow-white dots found on fundus exam. Indocyanine green angiography (ICGA) depicted hypofluorescent dots on late phase. Spectral-domain optical coherence tomography (SD-OCT) revealed numerous inner retinal highly reflective deposits in the outer nuclear layer and disruption of the ellipsoid zone. After initial improvement, he presented again for a sudden visual loss at 3 weeks. FFA, ICGA and SD-OCT demonstrated the same but more numerous and outer lesions suggesting an ASPPC. A full inflammatory work-up revealed highly positive titers of rapid plasma regain (RPR) and fluorescent treponemal antibody absorption (FTA-Abs), suggesting a syphilis infection. The ophthalmological manifestations dramatically improved after the patient was admitted for high-dose intravenous penicillin G 24 million per day for 2 weeks. CONCLUSION: This is the first case that reports an ocular syphilitic infection masquerading as MEWDS at presentation and that turns to be an ASPPC. Syphilis serology should be routinely done in every case of atypical MEWDS especially when unusually presented in a young healthy man, with bilateral involvement and a bad clinical evolution.
Subject(s)
Chorioretinitis/diagnosis , Eye Infections, Bacterial/diagnosis , Syphilis/diagnosis , White Dot Syndromes/diagnosis , Acute Disease , Anti-Bacterial Agents/therapeutic use , Chorioretinitis/drug therapy , Chorioretinitis/microbiology , Coloring Agents/administration & dosage , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Fluorescein Angiography/methods , Humans , Indocyanine Green/administration & dosage , Infusions, Intravenous , Male , Middle Aged , Multimodal Imaging/methods , Penicillin G/therapeutic use , Syphilis/drug therapy , Syphilis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , White Dot Syndromes/drug therapy , White Dot Syndromes/microbiologyABSTRACT
Purpose: To evaluate the potential clinical utility of wide-field swept source optical coherence tomography angiography (SS-OCTA) using a prototype device compared to a wide-field fundus autofluorescence (FAF) for analysis of the disease activity in eyes with tubercular serpiginous-like choroiditis (TBSLC). Methods: Using a prototype SS-OCTA device (PLEX Elite, Carl Zeiss Meditec, Dublin, CA), 17 eyes of 12 consecutive patients with TBSLC were imaged and multiple 12 mm × 12 mm OCTA scans were captured, which were montaged to create wide-field montage OCTA images scans. A wide- FAF (Eidon, CenterVue, Padova, Italy) was performed in the same sitting. Two masked graders independently analyzed OCTA and FAF images for the presence of choroidal lesions, recorded the number of lesions identifiable, and provided a subjective grading for the activity of individual lesion, which were then compared. Results: The total number of lesions identified on FAF were 282 (posterior pole lesions, n = 129 and peripheral lesions n = 153) and on wide-field SS-OCTA were 230 (posterior pole lesions, n = 108 and peripheral lesions n = 122). Active choroidal lesions were comparable on the two machines (n = 28 on FAF and n = 28 on SS-OCTA, respectively); whereas numerous healed lesions were identified on FAF (n = 219) as compared to SS-OCTA (n = 170). There was good correlation among the devices for healed lesions (Pearson correlation, r = 0.82) and active lesions (r = 0.88). Conclusion: There was good correlation between FAF and wide-field SS-OCTA for detection of disease activity in TBSLC; however, FAF depicted greater number of healed lesions compared to wide-field SS-OCTA.
