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A 54-year-old Caucasian male was referred to our clinic com­plaining of a significant loss of central vision in his right eye. Upon examination, his visual acuity was 5/200 in the right eye and 20/25 in the left; IOP was 14 mmHg in both eyes, and the color saturation in the right eye was decreased. Peripher­al fields were unaffected, but a large central scotoma was present in the right eye. Funduscopic exam revealed a blurred nasal disc margin in the right eye indicative of optic nerve edema. A large portion of the macula appeared slightly hypopigmented. This yel­lowish area fit the approximate contours of the scotoma.

The initial impression was choroiditis with associated optic neuritis. The patient admitted to being HIV-positive. His CD4 count from the previous month was normal and his viral load was undetectable. OCT showed a normal foveal contour—though red-free fundus photographs revealed flecking within the macula. Serologic tests came back positive for syphilis. After treatment with penicillin, his visual acuity was 20/40 and improved to 20/25 five months later.