Acute Syphilitic Posterior Placoid Chorioretinitis treated by Doxycycline and Benzathine Penicillin
Purpose
To report a case of syphilitic uveitis with acute syphilitic posterior placoid chorioretinitis(ASPPC) successfully treated with combination doxycycline and benzathine penicillin G(BPG) when refusal of intravenous(IV) treatment.
Methods
A retrospective case report.
Results
A 31 y/o man with a history of human immunodeficiency virus infection came for bilateral acute visual loss since 1 week ago. At presentation, the best corrected visual acuity(BCVA) was counting finger OD and 0.3 OS. Fundal examination was invisible OD and revealed a whitish placoid macular lesion OS. Left macular OCT showed loss of ellipsoid zone with many subretinal infiltrates. Systemic workup reported strong positive syphilis results. Early-phase fluorescein angiography showed a placoid hyperfluorescent staining macular lesion with blocked fluoresence in ICG angiography, which was well-demarcated in late-phase image, compatible with diagnosis of ASPPC. For refusal of IV treatment, he started with oral doxycycline 200mg/BID for 4 weeks. However, we found abnormal liver enzyme and persistent ocular inflammation, so he received a subsequent intramuscular BPG 2.4MU weekly for 3 weeks. After completing treatment, ocular inflammation was subsided and BCVA improved to 20/20 OU. 6 months after completing treatment, we found an 8-fold decrease of serum nontreponemal test , proving a lab evidence of treatment response. No recurrence was noted during 1-year follow-up period.
Conclusion
ASPPC is an uncommon but clinically distinct presentation of syphilitic uveitis. Our case report showed excellent treatment outcome of combination doxycycline and BPG when refusal of IV treatment.
Conflict of interest
No
Author 1
Last name
CHEN
Initials of first name(s)
HF
Department
Mackay Memorial Hospital
City
Hsinchu
Country
Taiwan
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