This fundus color photograph illustrates clinical manifestations of posterior syphilitic uveitis. The image shows widespread, small, circular, whitish-yellowish pre-retinal lesions (indicated by black arrows) scattered across the retina. These punctate lesions, sometimes referred to as pre-retinal precipitates, are seen overlying areas of active retinitis and often represent aggregates of inflammatory cells. A generalized haziness is visible across the fundus, characteristic of vitritis (inflammation of the vitreous humor), which obscures the clarity of the underlying retinal vessels and landmarks. The optic disc is visible in the nasal periphery with relatively preserved margins. This presentation is a classic hallmark of ocular syphilis, often termed 'the great mimicker,' where inflammatory cells migrate across the retina into the vitreous. This visual material serves as an educational resource for identifying inflammatory ocular phenotypes and distinguishing pre-retinal precipitates from intra-retinal foci in the context of infectious uveitis.

This clinical fundus photograph depicts the right eye of a patient with Acute Posterior Placoid Polymorphous Syphilitic Chorioretinitis (ASPPC), a rare ocular manifestation of secondary syphilis. The image demonstrates a characteristic large, circular, yellowish-white, placoid lesion at the level of the retinal pigment epithelium (RPE) and inner choroid, centrally located within the posterior pole. The surrounding retina displays a reddish-orange hue with visible retinal vasculature. Notably, several retinal vessels traversing the central lesion appear attenuated or partially obscured by the overlying inflammatory process. In the lower half of the fundus, there are linear, reddish streaks and subtle pigmentary changes radiating toward the periphery. The image illustrates the classic 'placoid' variant of syphilitic uveitis, emphasizing the importance of screening for Treponema pallidum in patients presenting with atypical posterior uveitis or placoid chorioretinal lesions.

This composite figure illustrates the multimodal clinical presentation of ocular syphilis, specifically punctate inner retinitis.

This clinical imaging composite presents two color fundus photographs (a and b) illustrating ocular manifestations of ocular syphilis in a patient with HIV. Image (a) displays the right eye with a hyperemic optic disc (indicated by a red arrow) and a large, creamy-yellow, plaque-like lesion in the posterior pole consistent with posterior placoid retinochoroiditis (yellow arrow). The lesion exhibits a ground-glass appearance. Image (b) shows the left eye with significant media haze caused by dense vitritis (indicated by a green arrow), which obscures clear visualization of retinal details. Despite the haze, a hyperemic optic disc is visible (red arrow), along with multiple, small, punctate yellowish lesions scattered across the posterior pole, identified as superficial retinal precipitates (blue arrows). These clinical findings are characteristic of syphilitic uveitis and retinitis. The imagery demonstrates key diagnostic features including disc edema, active chorioretinitis, and inflammatory vitreous debris, which are critical for the clinical assessment of multi-system infectious diseases.

This composite figure displays fundus photography and optical coherence tomography (OCT) of a patient's left eye, illustrating the progression of diabetic retinopathy complicated by syphilitic uveitis. Panels A and B are wide-field fundus photographs showing multiple retinal dot-and-blot hemorrhages, cotton-wool spots, and laser photocoagulation scars. Panel B, taken seven days post-vitrectomy, reveals an increasingly edematous macula compared to the baseline in A. Panels C, D, and E show corresponding OCT cross-sections. Image C (pre-vitrectomy) demonstrates a thickened epiretinal membrane (ERM) and significant intraretinal fluid (IRF) with cystic changes. Image D (post-operative day 1) shows anatomical alterations following ERM peeling. Image E (post-operative day 7) reveals a dramatic progression to massive subretinal fluid (SRF), indicated by a large hyporeflective space beneath the neurosensory retina, which coincided with high VDRL titers. The series illustrates how surgical intervention can trigger or coincide with an acute inflammatory/infectious exacerbation (ocular syphilis) in the setting of existing retinal vascular disease.

Clinical color fundus photographs of the right (a, b) and left (c, d) eyes demonstrating bilateral ocular syphilis and HIV-related posterior segment inflammation. The right eye (a, b) shows optic disc hyperemia (red arrow) and a widespread area of ground-glass retinochoroiditis (yellow arrow) in the inferior retina. Higher magnification (b) reveals numerous small, discrete, cream-colored superficial retinal precipitates (blue arrows) along the inferotemporal arcade, characteristic of acute syphilitic posterior placoid chorioretinitis. The left eye (c, d) demonstrates more severe inflammation with dense vitritis (green arrow) causing significant haze. Notable findings include a hyperemic optic disc (red arrow), a focal intraretinal hemorrhage superonasal to the disc (white arrow), and scattered superficial retinal precipitates (blue arrows) throughout the posterior pole. The images illustrate key diagnostic features of syphilitic uveitis and retinitis in the context of immunocompromise, highlighting the variation in severity and morphology between eyes, including placoid lesions, vitritis, and multifocal inflammatory precipitates.