Choroidal neovascularization secondary to ocular syphilis

Choroidal neovascularization (CNV) is a very rare but sight-threatening complication of ocular syphilis. We reported the case of a 51-year-old woman who presented with a 2-week history of visual loss in the right eye (RE). Fundus examination demonstrated vitritis and the optic disc margin blurring. Fundus fluorescein angiography (FFA) showed the presence of optic nerve edema, macular edema, and diffused impairment of the blood-retinal barrier with leakage areas, which led to the diagnosis of bilateral neuroretinitis. Optical coherence tomography (OCT) of the right macula evidenced irregularities of the retinal pigment epithelium (RPE), subretinal fluid and hyperreflective material. Besides, workup indicated positive serology for syphilis and the patient received combined treatment of ceftriaxone, systemic and topical steroids as well as cycloplegic medications. The woman did not consent to lumbar puncture or intravitreal anti-vascular epithelial growth factor (anti-VEGF) injection, therefore the prognosis for improvement of visual acuity is poor. Abbreviations: anti-VEGF = anti-vascular epithelial growth factor, AMD = age related macular degeneration, BCVA = best corrected visual acuity, CNS = central nervous system, CNV = choroidal neovascularization, CSF = cerebrospinal fluid, FFA = fundus fluorescein angiography, FTA-ABS = fluorescent treponemal antibody absorption, HIV = human immunodeficiency virus, iCNV = inflammatory CNV, IOP = intraocular pressure, LE = left eye, MRI = magnetic resonance imaging, OCT = optical coherence tomography, OCTA = optical coherence tomography angiography, RE = right eye, RPE = retinal pigment epithelium, RPR = rapid plasma regain, TP-PA = Treponema pallidum particle agglutination, VDRL = Venereal Disease Research Laboratory