Abstract

Patients presenting with low visual acuity (BAV) of acute installation, associated or not with field defects, without apparent fundoscopic changes, are labeled as possible carriers of retrobulbar optic neuritis. However, before starting a neurological investigation, some data from anamnesis and clinical examination are essential for the differential diagnosis with subclinical retinopathies (occult maculopathy).

This clinical report presents the case of a patient complaining of sequential bilateral central scotoma, with no apparent alteration in the background biomicroscopy, in which, due to some subtle clinical characteristics, it was possible to get rid of the diagnostic trap, which pointed to demyelinating retrobulbar neuritis.

Through the multimodal analysis of the retina, associated with other complementary exams, it was possible to identify that it was an infectious placoid neuroretinitis caused by syphilis.

The case presented here demonstrates the importance of delving into the signs and symptoms associated with low painless visual acuity or the presentation of central scotomas, in a patient with apparently normal fundoscopy. In the absence of a relative afferent defect and in the presence of positive visual symptoms (photopsia), it should be borne in mind that the most likely location remains the retina, ruling out the possibility of retrobulbar neuritis.

Keywords: Scotoma; Visual Acuity; Posterior Uveitis; Acute Posterior Multifocal Placental Pigment Epitheliopathy; Neurosyphilis

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