PURPOSE/METHODS: Acute syphilitic posterior placoid chorioretinitis causes visual loss in patients with secondary syphilis. The condition is characterized by vitreitis and large, yellow placoid lesions in the macula. We examined a patient with syphilis who had a serious retinal detachment and an exudative fluid meniscus (pseudohypopyon). RESULTS/CONCLUSIONS: Visual recovery and complete resolution of the chorioretinal lesion occurred after intravenous penicillin therapy. Secondary syphilis should be considered in the differential diagnosis of any patient with a macular pseudohypopyon.