Sequential spontaneous resolution of acute syphilitic posterior placoid chorioretinitis

Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a distinctive manifestation of ocular syphilis characterized by the development of a placoid macular deposit in the outer retina. Fundus autofluorescence descriptions suggest it may result from subretinal deposition of retinal pigment epithelium (RPE)-photoreceptor complex material and incomplete phagocytosis of outer segments. A 14-day therapy with systemic penicillin is essential for prompt control of the infection and to limit substantial retinal damage and irreversible visual loss. We report on the spontaneous sequential resolution of ASPPC in a patient with HIV coinfection.

Descriptive case report.

A 55-year-old man presented with profound decrease in vision in his left eye secondary to ASPPC. Nine days later, ASPPC resolved, and a similar process developed in the right eye. Four years earlier, HIV infection had been diagnosed, and the patient was maintained on antiretroviral therapy with good immune recovery (CD4+ T-cell count 204 cells/µL). Spontaneous resolution ensued in the right eye and vision was restored.

Ocular immune privilege probably contributed to the spontaneous resolution of ASPPC in this patient, who experienced immune recovery following antiretroviral therapy. The RPE immunologic characteristics likely contained the infectious/inflammatory infiltrate in this patient and prevented extension to inner retina and optic disc. Despite the uniqueness of the present case and the spontaneous resolution and excellent visual outcome, it remains essential to promptly manage patients with ocular syphilis because of the possible sight-threatening complications and to prevent potentially fatal disease.