IMAGE OF THE MONTH: March 2022

Shimmering lights and scotoma

Maxwell Stem, MD - Pennsylvania Retina Specialists, PC

24 y/o healthy man referred for “macula on retinal detachment OD”. Symptoms include shimmering lights in both eyes and a scotoma OD x 2 days. Examination and multimodal imaging of OS was completely normal

DIAGNOSIS


Ocular syphilis

The differential diagnosis for the placoid lesion and outer retinal disruption seen on the OCT in the right eye included AZOOR, APMPPE, and syphilis. The FA was not consistent with APMPEE because the lesion did not show any blockage early. The patient was asked to have his blood drawn for an RPR and FTA, both of which were positive. He was sent to an infectious disease specialist, and he had a PICC line placed. He completed a course of IV antibiotics and the lesion in the right eye, as well as his symptoms, completely resolved.

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