Spectral optical coherence tomography findings in an adult patient with syphilitic bilateral posterior uveitis and unilateral punctate inner retinitis

Abstract

Purpose: To describe the spectral domain optical coherence tomography (SD-OCT) features of a punctate inner retinitis, a rare ocular manifestation of syphilis, in an HIV positive adult patient.

Observations: In the right eye, SD-OCT images during the active period showed hyperreflectivity of the full thickness of the inner retina, precluding the individualization of the layers. In addition, multifocal areas with higher hyperreflectivity were identified within the affected retina. Once the lesion became inactive, SD-OCT images revealed inner retina layers atrophy, disruption of the ellipsoid layer, and multifocal damage to the retinal pigment epithelium layer.

Conclusion and importance: Punctate inner retinitis affects the full thickness retina, leading to severe retinal damage, along with multifocal damage of the retinal pigment epithelium. The multifocal white retinal lesions observed within the affected retinal area correlated with the presence of intense hyperreflective dots within the retina showed by SD-OCT. These lesions are deeper than was described in other reports.

Keywords: Human immunodeficiency virus; Ocular syphilis; Posterior uveitis; Punctate inner retinitis; Spectral domain optical coherence tomography.

Fig. 1

a) OD color fundus photograph. Multiple white infiltrates apparently located at the retinal surface can be seen, resting on an area of the retina with a “ground glass” appearance at the superior nasal periphery. b) SD-OCT at the level of the “ground glass” retina. Hyperreflective dots infiltrating the retina were observed, precluding the individualization of the layers, with the exception of the RPE. A barely apparent serous retinal detachment can be observed in the temporal border of the retinal lesion. c) SD-OCT at the level of the apparently superficial retinal white dots. Focal areas of dense hyperreflectivity within the retina were observed. d) SD-OCT at the level of the fovea. A serous foveal detachment can be appreciated. Image quality is poor due to vitreous haze. e) OD color fundus photograph after antibiotic treatment. Note the presence of multifocal areas of RPE atrophy at the superior nasal periphery. f) SD-OCT at the level of the focal depigmented lesions. Note the inner retina layers' atrophy and focal disruption of the RPE layer. The underlying choroid seems to be unaffected. g) SD-OCT at the level of the fovea. Note the resolution of the foveal serous detachment. . (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

a) OS color fundus photograph. A whitish retinal lesion located at the superior nasal periphery can be noted. b) color fundus photograph. A whitish retinal lesion located over the superior temporal vascular arcades can be observed. c) SD-OCT at the level of the fovea. As can be noted, the foveal structure was without remarkable signs. Note some hyperreflective dots at the level of the vitreous, and an elevated papilla, corresponding to an inflammation of this structure. d) OS color fundus photograph after antibiotic treatment. Multifocal areas of RPE atrophy at the superior nasal periphery can be observed. e) SD-OCT at the level of the fovea. A persistent elevated temporal border of the optic disk can be noted. The fovea was normal, and the hyperreflective dots at the vitreous disappeared. . (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)