title: Superficial retinal precipitates in patients with syphilitic retinitis.
abstract: OBJECTIVE
  The purpose of this study was to describe the occurrence of superficial retinal precipitates in patients with syphilitic retinitis.
  
  
  METHODS
  This was a retrospective, observational case series of nine eyes of eight patients with syphilitic retinitis associated with superficial retinal precipitates. The clinical, photographic, angiographic, and laboratory records were reviewed. Characteristics and treatment response of these superficial retinal precipitates were observed.
  
  
  RESULTS
  All patients were Caucasian men, including 5 men who have sex with men (62.5%) and 6 (75.0%) who were positive for human immunodeficiency virus. None of the patients were previously diagnosed with syphilis. All patients developed panuveitis and a distinctly diaphanous or ground-glass retinitis associated with creamy yellow superficial retinal precipitates. In 3 patients (37.5%), the retinitis had a distinctive wedge-shaped appearance. Five patients (62.5%) had associated retinal vasculitis, 3 (37.5%) had serous retinal detachment, 2 (22.2%) had intraretinal hemorrhage, and 2 (22.2%) had papillitis. Within 2 weeks of initiating intravenous penicillin treatment, 7 patients (87.5%) experienced visual recovery to >or= 20/40. All affected eyes showed rapid resolution of clinical signs with minimal alternations of the retinal pigment epithelium in areas of prior retinitis after completion of antibiotic therapy.
  
  
  CONCLUSIONS
  Characteristic superficial retinal precipitates may occur over areas of syphilitic retinitis. Improved recognition of this highly suggestive clinical sign may aid in early diagnosis and treatment.
authors.affiliation: San Francisco Retina Foundation, San Francisco, California, USA.
authors.forename: Evelyn X
authors.initials: EX
authors.lastname: Fu
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Geraets
authors.forename: Emilio M
authors.initials: EM
authors.lastname: Dodds
authors.forename: Laura V
authors.initials: LV
authors.lastname: Echandi
authors.forename: Daniel
authors.initials: D
authors.lastname: Colombero
authors.forename: H Richard
authors.initials: HR
authors.lastname: McDonald
authors.forename: J Michael
authors.initials: JM
authors.lastname: Jumper
authors.forename: Emmett T
authors.initials: ET
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006679:HIV Seropositivity / Q000175:diagnosis; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000627:therapeutic use; D012160:Retina / Q000473:pathology*; D012173:Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013588:Syphilis Serodiagnosis; D014792:Visual Acuity; D044465:White People
chemical_list: D010400:Penicillin G