Indian Journal of Ophthalmology

LETTER TO EDITOR
Year
: 2004  |  Volume : 52  |  Issue : 3  |  Page : 254--5

Leutic chorioretinitis in an immunocompromised patient.


A Pathengay, B Raju, A Mathai 
 

Correspondence Address:
A Pathengay





How to cite this article:
Pathengay A, Raju B, Mathai A. Leutic chorioretinitis in an immunocompromised patient. Indian J Ophthalmol 2004;52:254-5


How to cite this URL:
Pathengay A, Raju B, Mathai A. Leutic chorioretinitis in an immunocompromised patient. Indian J Ophthalmol [serial online] 2004 [cited 2020 Jan 28 ];52:254-5
Available from: http://www.ijo.in/text.asp?2004/52/3/254/14577


Full Text

Dear Editor,

Ocular manifestations of syphilis in patients with human immunodeficiency virus (HIV) include optic neuritis, necrotising retinitis and vitritis. Patients at risk for sexually transmitted HIV are also at risk for developing syphilis. Gass and associates have described acute syphilitis posterior placoid chorioretinitis involving the outer retina and pigment epithelium in immunosuppressed patients.[1]

We describe a bilateral simultaneous presentation of placoid chorioretinitis and retinal vasculitis in a patient seropositive for HIV. A 45-year-old man presented with a history of blurred vision in both eyes of 15 days' duration. Visual acuity was counting fingers close to face in the right eye and 6/15; N24 in the left eye. Slitlamp examination of the anterior segment was normal. Vitreous had +1 cells in both the eyes. Pale yellow placoid lesions [Figure 1] a and b were seen at the level of retinal pigment epithelium temporal to the macula in the right eye and nasal to the optic disc in both eyes. Over the placoid lesions, neurosensory elevation with sheathing of the vessels and retinal haemorrhages were noted. The fundus fluorescein angiography (FFA) of the placoid lesions showed early hypofluorescence and late staining. Perifoveal vessel leakage was noted in the left eye.

There was history of exposure to commercial sex workers. Systemic evaluation for syphilis was unremarkable. Positive laboratory tests for HIV and syphilis were obtained from ELISA and serum VDRL respectively. The patient was treated with 4 million units of intravenous penicillin every 4 hours for 10 days, followed by 3 weekly intramuscular injections of 2.4 million units of benzathine penicillin.[2] Forty days after treatment, the placoid lesions faded [Figure 2] a and b vision improved to 6/9 in both eyes. The patient could not afford further treatment for HIV.

The incidence and prevalence of HIV in India is rising but only one case of ocular syphilis has been reported.[3] This could probably be due to misdiagnosis of typical fundus lesions observed in immuno-compromised patients.

Syphilits chorioretinitis can manifest in a patchy diffuse form or as a placoid, pale yellow subretinal lesion depending on the host immunological status.[1] The presence of placoid-like chorioretinal lesions in our patient led us to presume ocular syphilis in an immuno-compromised individual.[1]

Systemic findings of syphilis in an HIV patient may not be present at the time of diagnosis of ocular syphilis, as observed in our patient. Ocular syphilis is treated as per the neurosyphilis regiment.[2] This treatment often leads to resolution of both the signs and symptoms as noted in our patient.

Our case reemphasises deep, yellow placoid lesions as a clinical manifestation of ocular syphilis in HIV patients who present with chorioretinitis. Prompt diagnosis and appropriate treatment provides excellent visual results.

References

1Gass JDM, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis. Ophthalmology 1990;97:1288-97.
2Berry C, Hootan T, Collier A, Lukehart S. Neurological relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med 1987;316:1587-89.
3Biswas J, Madhavan HN, Amala AE, Kumarasamy N, Solomon S. Ocular lesions associated with HIV infection in India: A series of 100 consecutive patients evaluated at a referral centre. Am J Ophthalmol 2000;129:9-15.