Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare clinical manifestation of ocular syphilis. treatment, the presence of a placoid macular lesion should raise a high suspicion of ASPPC in order to make a timely diagnosis and to avoid progression of untreated syphilis. [1]. Syphilis is a re-emerging and rising infection in the developed world. In up to one-quarter of patients with syphilis, ocular involvement manifests at any time during the disease course. Ocular syphilis may precede the diagnosis of systemic disease in up to one-half of cases [2]. Ocular syphilis, known as the great masquerader, may affect almost every structure of the eye and has a broad spectrum of presentation, including, among others, interstitial keratitis, optic neuropathy and posterior uveitis, the latter commonly represented by chorioretiniti [3], [4]. In 1988, de Souza et al. [5] reported three young patients with unilateral central chorioretinitis as manifestation of ocular syphilis. Two years later, Gass et al. [6] reported six additional similar cases. They concluded that this condition was a separate clinical entity, and coined the term acute syphilitic posterior placoid chorioretinitis (ASPPC). ASPPC is defined by the presence of one or more placoid, yellowish, outer retinal lesions, typically involving the posterior pole and the mid-periphery of the retina near the temporal vascular arcade [6]. ASPPC may have a unilateral or bilateral involvement with a presenting visual acuity ranging from 20/20 to no light perception [7]. The advent of multimodal imaging (MMI) of the retina, especially of spectral domain optical coherence tomography (SD-OCT), has made it possible to report pathognomonic features of ASPPC, which include punctate hyperreflectivity in the choroid, disruption and loss of the ellipsoid zone, nodular irregularity of the retinal pigment epithelium, and transient localized subretinal fluid [8], [9]. Since patients with ASPPC usually receive prompt antimicrobial treatment after serologic results, little is known about the natural course of the disease. To the best of our knowledge, only 5 cases of ASPPC with spontaneous improvement have been reported [10], [11], [12], [13]. We report the natural course and the multimodal retinal imaging features of an additional case, and discuss the pathogenetic implications and the importance of early recognition of this rare clinical entity. Case presentation A 45-year-old man with no relevant past medical history presented to the eye casualty service complaining of sudden onset central white ring and decreased vision in the right eye (RE) over the past seven days. Best-corrected visual acuity (BCVA) was 6/12 in the right eye and 6/6 in BD-AcAc 2 the left eye (LE). Intraocular pressure was 14 mmHg in both eyes. Examination of Rabbit Polyclonal to FA7 (L chain, Cleaved-Arg212) the RE showed no cells in the right anterior chamber and 1+ vitreous cells; fundus examination revealed a yellow placoid lesion involving the macular area with no signs of vasculitis or retinal necrosis. Examination of the LE was unremarkable. MMI of the retina including colour fundus photograph, fundus autofluorescence, SD-OCT, fluorescein angiography and indocyanine green angiography are presented in Figure 1 (Fig. 1), Figure 2 (Fig. 2), and Figure 3 (Fig. 3). Open in a separate window Figure 1 Fluorescein angiography (FA) and indocyanine green angiography (ICGA) of acute syphilitic posterior placoid chorioretinitis in the right eye at presentation. (a) Early frame of FA shows hypofluorescence (yellow arrowhead) of the placoid lesion which appears hyperfluorescent in the late frames (b). (c), (d) ICGA shows hypocianescence of the placoid lesion (green arrowhead) throughout the whole examination. Open in a separate window Figure 2 Colour fundus photograph (CFP) and fundus autofluorescence (FAF) changes of acute syphilitic posterior placoid chorioretinitis in the right eye over time. (a) CFP shows a yellow placoid lesion (white arrowhead) at the posterior pole which gradually fades 1 week after presentation (b) and 2 weeks after presentation (c). FAF shows increased AF in correspondence of the placoid lesion BD-AcAc 2 at presentation (d) with gradual normalisazion of the AF 1 week after presentation (e) and 2 weeks after presentation (f). Open in a separate window Figure 3 (a) Spectral domain optical coherence tomography (SD-OCT) scan of the right eye at presentation shows disruption of the ellipsoid zone (white asterisks), nodular thickening of the retinal pigment epithelium (yellow arowheads) and punctate hyperreflectivity in the inner choroid (white arrows). SD-OCT scan 1 BD-AcAc 2 week after presentation (b) and 2 weeks after presentation (c) show gradual recovery of the ellipsoid zone and retinal pigment epithelium. The medical history was carefully reviewed; the patient admitted to be addicted to poppers.