Sequential spontaneous resolution of acute syphilitic posterior placoid chorioretinitis

Purpose: Acute syphilitc posterior placoid chorioretnits (ASPPC) is a distnctve manifestaton of ocular syphilis characterized by the development of a placoid macular deposit in the outer retna. Fundus autofuo-rescence descriptons suggest it may result from subretnal depositon of retnal pigment epithelium (RPE)– photoreceptor complex material and incomplete phagocytosis of outer segments. A 14-day therapy with systemic penicillin is essental for prompt control of the infecton and to limit substantal retnal damage and irreversible visual loss. We report on the spontaneous sequental resoluton of ASPPC in a patent with HIV coinfecton. Methods: Descriptve case report. Results: A 55-year-old man presented with profound decrease in vision in his lef eye secondary to ASPPC. Nine days later, ASPPC resolved, and a similar process developed in the right eye. Four years earlier, HIV infecton had been diagnosed, and the patent was maintained on antretroviral therapy with good immune recovery (CD4+ T-cell count 204 cells/µL). Spontaneous resoluton ensued in the right eye and vision was restored. Conclusions: Ocular immune privilege probably contributed to the spontaneous resoluton of ASPPC in this patent, who experienced immune recovery following antretroviral therapy. The RPE immunologic characteristcs likely contained the infectous/infammatory infltrate in this patent and prevented extension to inner retna and optc disc. Despite the uniqueness of the present case and the spontaneous resoluton and excellent visual outcome, it remains essental to promptly manage patents with ocular syphilis because of the possible sight-threatening complicatons and to prevent potentally fatal disease.