title: Multimodal imaging analyses of hyperreflective dot-like lesions in acute syphilitic posterior placoid chorioretinopathy.
abstract: BACKGROUND
  Retrospective review of one acute syphilitic posterior placoid chorioretinitis (ASPPC) case with serological evidence of syphilis who had ocular signs and symptoms not attributable to other diseases. Enface and spectral-domain optical coherence tomographySD-OCT were analyzed at the time of presentation and at 1-month visit following initiation of treatment. The study patient underwent standard treatment for neurosyphilis.
  
  
  RESULTS
  Ophthalmic examination and imaging studies were consistent with the diagnosis of ASPPC. The patient age was 33 year-old and the baseline visual acuity was 20/400 and 20/80 in the right and left eyes, respectively. At presentation, SD-OCT scans showed disruption and loss of the ellipsoid zone (EZ), small nodular elevations on retinal pigment epithelium (RPE) and punctate hyperreflectivity in the choroid. Enface OCT at the level of RPE and EZ demonstrated multiple hyperreflective dot-like lesions simmetrically distributed within the macular area. These dot-like lesions corresponded to the small nodular elevations on RPE and to disruption/loss of EZ observed with SD-OCT. One month after neurosyphilis therapy, the visual acuity improved and the outer retinal changes partially reversed in both eyes.
  
  
  CONCLUSIONS
  We report the outer retinal findings and its correlation using both en-face and SD-OCT in a patient with ASPPC. En-face OCT imaging provides a more precise outer retinal layers analyses allowing a better understanding of the ASPPC pathophysiology.
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. luizlima9@gmail.com.|Federal University of São Paulo (UNIFESP), Rua Botucatu, 821, Vila Clementino, São Paulo, SP 04023-062, Brazil. luizlima9@gmail.com.
authors.forename: Luiz H
authors.initials: LH
authors.lastname: Lima
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Gabriel Costa
authors.initials: GC
authors.lastname: de Andrade
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Silvana
authors.initials: S
authors.lastname: Vianello
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.|Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile.
authors.forename: Claudio
authors.initials: C
authors.lastname: Zett
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Michel E
authors.initials: ME
authors.lastname: Farah
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rubens
authors.initials: R
authors.lastname: Belfort
keywords: Acute syphilitic posterior placoid chorioretinitis; En-face optical coherence tomography; Outer retinal abnormalities; Spectral-domain optical coherence tomography; Syphilis