Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 3268
  • Home
  • Print this page
  • Email this page

   Table of Contents      
COMMENTARY
Year : 2020  |  Volume : 68  |  Issue : 9  |  Page : 1964

Commentary: Neuroretinitis, frosted branch angiitis and paracentral acute middle maculopathy in a young female


Department of Vitreoretina, M M Joshi Eye Institute, Gokul Road, Hosur, Hubballi, Karnataka, India

Date of Web Publication20-Aug-2020

Correspondence Address:
Dr. Apoorva Ayachit
Department of Vitreoretina, M M Joshi Eye Institute, Gokul Road, Hosur, Hubballi - 580021, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1113_20

Rights and Permissions

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

How to cite this URL:
Ayachit A, Ayachit G. Commentary: Neuroretinitis, frosted branch angiitis and paracentral acute middle maculopathy in a young female. Indian J Ophthalmol [serial online] 2020 [cited 2020 Sep 23];68:1964. Available from: http://www.ijo.in/text.asp?2020/68/9/1964/292507



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 Top

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.  Back to cited text no. 1
    
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.  Back to cited text no. 2
  [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.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    
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.  Back to cited text no. 5
    




 

Top
 
 
  Search
 
    Similar in PUBMED
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed116    
    Printed1    
    Emailed0    
    PDF Downloaded37    
    Comments [Add]    

Recommend this journal