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Case 17


Patient Presentation: A 43-year-old man with no PMHx or POHx presented to a tertiary retina clinic with 2-weeks of painless blurred vision. The blurred vision started with his right eye 2 weeks ago, but for the last 5 days, his left eye vision has also become distorted. He denied eye pain, redness, flashes, or a visual field deficit; however, he did note new intermittent floaters OU. He denied trauma. He has never taken prescription medication.

On examination, visual acuity was 20/50 OD and 20/40 OS. IOP was within-normal-limits and there was no RAPD. Anterior segment examination revealed fine keratic precipitates OU, 1+ AC cells OU, no posterior synechiae or lens changes, and 1+ vitreous cells. Fundus photographs were taken and are shown below:


OCT macula images were also taken, and are shown below:


Question 1: What are the main findings in the OCT macula images above?

Question 2: What is the next step in your examination of this patient?

On review of systems, the patient adamantly denied any neurological, cardiac, respiratory, GI or GU symptoms. He was born in Canada and denied and recent travel. However, when taking a sexual history, he finally disclosed that he was having extra-marital sexual encounters with other men. When asking him to inspect his skin, a maculopapular rash was found on his trunk, palms of his hand, and soles of his feet.

Next, fundus autofluorescence imaging was taken and is shown below:


Question 3: Based on the patient’s fundus photographs, OCT macula images, review of systems and FAF images, what is the most likely diagnosis?

A standard uveitic panel, including CBC, ACE, syphilis serology, quantiferon-gold, HLA-B27, ANCA, and chest x-ray was completed. His syphilis serology returned as positive! He was admitted to General Medicine and referred to Infectious Diseases for urgent IV Penicillin treatment.

Learning Objectives:

  1. Describe the typical OCT findings in syphilitic placoid chorioretinitis

  2. Understand the typical review of systems and work-up for uveitis entities

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