Ocular Syphilis mimicking Acute Zonal Occult Outer Retinopathy (AZOOR)

Ocular syphilis can simulate various ophthalmic pathologies with multiple possible ophthalmic findings. Timely treatment of these patients can minimize visual damage, but its diagnosis is often a challenge for the ophthalmologist. We review a case report of a 45-year-old man with a rare and atypical clinical presentation of ocular syphilis, its clinical and imaging characteristics, its diagnosis, treatment and evolution. The patient presented with bilateral painless loss of vision, photopsia and peripheral scotomas with about 1 week evolution. There were no signs of ocular inflammation. The complementary ophthalmic study revealed an acute zonal occult outer retinopathy-like ("AZOOR-like") presentation. Ocular syphilis does not always present with ocular inflammation and its presentation as "AZOOR-like" is very rare. So, we should always maintain a high index of suspicion for this condition, as early diagnosis and treatment are essential for a better prognosis.