LAUSR

A 60-year-old man, with no known history of HIV, ocular or sexually transmitted infections, presented with new onset flashing lights and decreased vision in his right eye (Snellen 20/200) for 4 days. Dilated fundoscopic examination (Fig. 1) revealed a whitish placoid chorioretinal lesion in the superonasal macula (A) that exhibited abnormal hyperautofluorescence with an active leading edge on fundus autofluorescence imaging (B). OCT (C) showed a constellation of findings that are pathognomonic for acute syphilitic posterior placoid chorioretinitis (ASPPC), such as disruption of ellipsoid zone, irregular RPE nodular thickening, subretinal fluid and punctate hyperreflectivity in the choroid.1,2 Laboratory testing confirmed the presence of Treponema Pallidum IgG, with a RPR titer of 1:32. Patient’s visual acuity improved to 20/20 at his 4-month follow-up, after completion of 14 days of IV penicillin G 3,000,000 units given every 4 h.