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Asymptomatic Retinal Gumma

Douglas K. Sigford, MD1; Shlomit Schaal, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky
JAMA Ophthalmol. 2015;133(3):355-357. doi:10.1001/jamaophthalmol.2014.5232.
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Ocular syphilis, caused by the spirochete Treponema pallidum, presents a diagnostic dilemma because of the myriad ways in which it can appear. Anterior scleritis, uveitis involving any portion of the uveal tract, retinitis, retinal vasculitis, optic neuritis, diffuse retinal edema, exudative retinal detachment, and acute syphilitic posterior placoid chorioretinitis have all been described with varying degrees of regularity.13 Gummata, or luetic granulomas, result from tertiary syphilis. They are most commonly found in the liver but can be found in other organs. They are formed by local reactions to spirochetes after the immune system fails to kill them. Herein, we describe a case of an asymptomatic retinal gumma without active intraocular inflammation.

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Figure 1.
Color Fundus Photograph, Fluorescein Angiograms, and Indocyanine Green Angiograms of the Right Eye on Presentation

A, Color fundus photograph shows neurosensory retinal detachment involving the fovea with an underlying poorly demarcated yellow/white lesion and small subretinal yellow lesions. B and D, Early-phase (B) and late-phase (D) fluorescein angiograms show patchy hyperfluorescence without vasculitis or leakage from the optic nerve. C and E, Early-phase (C) and late-phase (E) indocyanine green angiograms show deep hyperfluorescence without optic nerve edema.

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Figure 2.
Optical Coherence Tomography Through the Center of the Neurosensory Detachment

A, Optical coherence tomography on presentation demonstrates subretinal fluid, hyperreflective foci, and disrupted retinal pigment epithelium including ill-defined subretinal hyperreflectivity. B, Two weeks after treatment with intravenous penicillin. C, Three months after treatment. D, Six months after treatment.

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