Spontaneous Resolution of Bilateral Acute Syphilitic Posterior Placoid Chorioretinopathy: Multimodal Imaging Findings and Literature Review

Syphilis is a sexually transmitted infection caused by the Gram‐negative spirochete bacterium Treponema pallidum . Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is a distinctive and increasingly recognized ocular manifestation characterized by the presence of one or more round to oval yellowish placoid outer retinal lesions at the level of the retinal pigment epithelium (RPE) in the macular area. Spontaneous resolution of this entity has been described in the literature. Our aim is to describe a case with bilateral spontaneous improvement of ASPPC along with multimodal imaging findings including optical coherence tomography angiography (OCTA). A 46‐year‐old male presented with bilateral decreased vision, flashes, and floaters in both eyes. Fundus examination revealed mild vitritis and placoid lesions in the macular and perimacular regions. Multimodal imaging, including spectral domain optical coherence tomography (SD‐OCT) and OCTA, confirmed the diagnosis of ASPPC. Despite delays in receiving systemic antibiotic treatment, the patient experienced spontaneous ocular improvement over several months. The pathophysiology of ASPPC remains elusive, and the literature provides contrasting evidence on the role of the immune response. Given that spontaneous improvement has been reported, a higher index of suspicion for ASPPC in a patient presenting with a placoid macular lesion is warranted. Prompt and comprehensive treatment strategies are critical to managing such cases and preventing further complications and vision loss.