Multimodal Imaging in Ocular Syphilis

A 60 year-old-man with a 3-month history of painless blurred vision was found to have bilateral disc edema. Visual function was unremarkable OU except for enlargement of the blind spot OS. Brain and Orbits MRI showed mild enhancement at the left optic disc insertion and optic disc edema OS. Multimodal ocular imaging showed leakage of optic nerve head and peripheric retinal veins and capillaries OU, Placoid lesions with increased autofluorescence signal OU and nodular irregularities at the level of the retinal pigment epithelium and segment loss of the ellipsoid zone OU. Laboratory work up was positive for syphilis. One must consider multimodal ocular imaging and infectious investigation in painless and longstanding vision loss associated with bilateral disc edema.