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COMMENTARY |
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Year : 2020 | Volume
: 68
| Issue : 9 | Page : 1964 |
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Commentary: Neuroretinitis, frosted branch angiitis and paracentral acute middle maculopathy in a young female
Apoorva Ayachit, Guruprasad Ayachit
Department of Vitreoretina, M M Joshi Eye Institute, Gokul Road, Hosur, Hubballi, Karnataka, India
Date of Web Publication | 20-Aug-2020 |
Correspondence Address: Dr. Apoorva Ayachit Department of Vitreoretina, M M Joshi Eye Institute, Gokul Road, Hosur, Hubballi - 580021, Karnataka India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/ijo.IJO_1113_20
How to cite this article: Ayachit A, Ayachit G. Commentary: Neuroretinitis, frosted branch angiitis and paracentral acute middle maculopathy in a young female. Indian J Ophthalmol 2020;68:1964 |
Ocular syphilis, also known as the great masquerader, can present in myriad forms. In a large cohort, posterior uveitis with associated retinitis was the most common presentation, accounting for 77% of uveitis. Anterior uveitis, intermediate uveitis, and vasculitis made up less than 10% of the cases.[1]
The authors, in the given case, present a cluster of findings viz. neuroretinitis, frosted branch angiitis and paracentral acute middle maculopathy (PAMM) in a case of syphilitic posterior uveitis.[2] They make a diagnosis of ocular syphilis based on serologic testing and histopathology. A cerebrospinal fluid (CSF) analysis also can be contributory in these cases. Frosted branch angiitis (FBA) has been previously described in ocular syphilis. Other causes of FBA include cytomegalovirus retinitis, herpes simplex, autoimmune disorders, and leukemias.[3]
Typically, the term neuroretinitis is reserved for the findings of disc edema and macular star seen commonly in cat-scratch disease, toxoplasmosis, herpes simplex retinitis, Lyme disease, and has been described before in syphilitic uveitis as well.[4]
The third finding that the authors describe in their case is PAMM. In a large cohort, although vasculitis was seen in nearly a quarter of cases of ocular syphilis, vascular occlusions were not reported even in eyes with extensive vasculitis.[1] Thus, the finding of PAMM suggests an occlusion that preferentially affected the intermediate and deep capillary plexuses in this case. Hitherto mentioned causes of PAMM include use of vasopressors, migraine, preceding viral illness and accelerated hypertension.[5] This feature on optical coherence tomography adds to the plethora of findings in syphilitic posterior pole involvement and also adds to the etiological spectrum of PAMM.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
1. | Furtado JM, Arantes TE, Nascimento H, Vasconcelos-Santos DV, Nogueira N, de Pinho Queiroz R, et al. Clinical manifestations and ophthalmic outcomes of ocular syphilis at a time of re-emergence of the systemic infection. Sci Rep 2018;8:1-8. |
2. | Singh SR, Dogra M, Thattaruthody F, Singh R, Dogra MR. Neuroretinitis, frosted branch angiitis, and paracentral acute middle maculopathy in a young female. Indian J Ophthalmol 2020;68:1962-3. [Full text] |
3. | Anderson AM, Bergstrom CS. Syphilitic frosted branch angiitis with anterior uveitis in a patient with a new HIV diagnosis. Lancet Infect Dis 2009;9:453. |
4. | Triningrat AM, Budi NM, Juliari I, Surasmiati NM, Siska S, Suryaningrum IR. Neuroretinitis syphilis in human immunodeficiency virus-infected patient. Open Access Maced J Med Sci 2019;7:1987-90. |
5. | Rahimy E, Kuehlewein L, Sadda SR, Sarraf D. Paracentral acute middle maculopathy: What we knew then and what we know now. Retina Phila Pa 2015;35:1921-30. |
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