FP646

The return of the Great Masquerader

Purpose: To report a case of Necrotising Syphilitic retinitis masquerading as Acute retinal necrosis after periocular triamcinolone acetate injection

Material and Methods: A 28 year old male presented with defective vision, redness and pain in the right eye. He
had received a single dose of periocular steroid by the referring physician. His BCVA was 5/60 in right eye and 6/6 in left eye.
 
Results: After thorough ophthalmic evaluation, a provisional diagnosis of Panuveitis / Viral uveitis was made. Serology revealed positivity for TPHA and HIV . With appropriate treatment for syphilis, BCVA in the right eye
dramatically improved to 6/6

Conclusion: Syphilitic uveitic lesions are non necrotising . Pre treatment with IVTA without appropriate diagnostic evaluation can convert  non necrotising retinitis  into a necrotising disease masquerading as Viral retinitis. Hence timely diagnosis and appropriate treatment can lead to dramatic visual recovery.