Syphilitic Posterior Placoid Chorioretinitis

A 62-year-old human immunodeficiency virus (HIV)–positive Caucasian man presented with 3 days of painless vision loss in the left eye. The right eye demonstrated optic disc edema and the left a deep, orange-yellow placoid lesion in the posterior pole. A broad differential diagnosis was entertained, including syphilis, viral retinitis, tuberculosis, primary toxoplasmosis, and endogenous infectious chorioretinitis. Syphilis serology was positive, and the patient responded to intravenous penicillin combined with prednisone.