Posterior placoid chorioretinitis: An unusual ocular manifestation of syphilis

There appears to be a re-emergence of syphilis in recent times despite a steady decline in incidence for the past decade. Diagnosis of syphilis can be clinically challenging and ocular manifestations of syphilis have a myriad of presentations and severity. Ocular syphilis can occur at any stage of the disease and may also be the only presenting sign of syphilis. We report a case of acute unilateral maculopathy, due to posterior placoid chorioretinitis associated with syphilis, in an immunocompetent patient. Ophthalmoscopy revealed a unilateral yellowish placoid lesion at the macula. Syphilis serology was positive confirming active infection. There were no other systemic signs of syphilis. The patient was treated with intravenous benzylpenicillin 1.2 g every four hours for two weeks. The lesion resolved with treatment and the retinal appearance returned to normal. This case highlights the importance of raising clinical suspicion of syphilis in view of unexplained decreased vision and ocular inflammation.