Multimodal Imaging of a Unique Transitory Finding in Ocular Syphilis

Purpose: To describe a unique finding in ocular syphilis using multimodal imaging. Methods: A single case was analyzed. Results: A 52-year-old man presented with chronic syphilitic posterior uveitis and was treated with intravenous and intramuscular penicillin for systemic manifestations, topical steroids, and unilateral bevacizumab for secondary macular neovascularization. Bilateral transitory outer retinal microcysts were subsequently seen on optical coherence tomography, with an appearance distinct from outer retinal lesions found in other degenerative retinal diseases. Conclusions: Longstanding smoldering inflammation in this patient resulted in retinal pigment epithelium disruption and subsequent overlying photoreceptor rearrangement with microcyst formation. The spontaneous resolution and reappearance of these lesions elsewhere, despite previous treatment, may offer further insight into localized retinal tissue response from treponemal disease.