PMC6377954_01
Baseline imaging results. (a) Optical coherence tomography upon initial presentation was unremarkable. (b) Fluorescein angiography at the first visit revealed focal hyperfluorescence inferior to the optic nerve in the right eye (top) and vasculitis of the inferotemporal vessels in the left eye (bottom). (c) Fundus photos upon initial presentation. Normal retinal vessels in the right eye. Peripheral retinitis with white yellow necrotic retina and slight disc edema in the left eye.
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Optical coherence tomography (OCT) findings were unremarkable (Figure 1(a)). Fluorescein angiography (FA) revealed focal hyperfluorescence in the right eye and vasculitis in the left eye (Figure 1(b)). Fundus photography was unremarkable for the right eye but revealed peripheral retinitis, slight disc edema, and 2+ vitritis in the left eye (Figure 1(c)).
Imaging results 21 days after initial presentation. (a) Optical coherence tomography of the right eye (top) showed vitreous debris with no evidence of subretinal fluid. The view of the left eye (bottom) was limited due to heavy vitreous debris. (b) Fluorescein angiography following visual decline. There are marked retinitis and vitreous debris in the right eye (top) and limited views due to heavy vitreous debris in the left eye (bottom). (c) Fundus photos revealed vitreous debris with 1+ vitritis and peripheral retinitis in the right eye. Heavy vitreous debris with 4+ vitritis causing limited views in the left eye.
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FA, and fundus views were all limited in the left eye due to worsening of the vitreous debris (Figure 2). From limited views, physical exam revealed 1+ vitritis in the right eye and 4+ vitritis in the left eye (Figure 2(c)). FA of the right eye showed retinitis superiorly and inferiorly, which extended into the macula (Figure 2(b)).
Syphilis screening algorithms. Traditional serologic screening (a) compared to reverse sequence serologic screening (b). Screening algorithms adopted from CDC recommendations. RPR, rapid plasma reagin; TP-PA, Treponema pallidum particle agglutination; EIA, enzyme immunoassay; CIA, chemiluminescence immunoassay.
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However, this time, the patient was tested using the alternative serologic screening algorithm for syphilis, which tests directly for treponemal antibodies (Figure 3).