Abstract
BackgroundToxoplasma retinochoroiditis can have an atypical presentation and be difficult to diagnose in immunocompromised patients. Accurate diagnosis and appropriate treatment is important since the disease can be aggressive in these patients. This paper is a case report with literature review, emphasizing on the diagnosis and treatment of Toxoplasma retinochoroiditis.FindingsA 27-year-old male with chronic myelogenous leukemia with history of bone marrow transplantation presented with floaters in his right eye. Fundus exam showed bilateral, multifocal retinochoroiditis with subsequent development of a mild vitritis. Serum cytomegalovirus and toxoplasmosis antibody titers and syphilis screen were negative. Aqueous polymerase chain reaction (PCR) analysis revealed the presence of Toxoplasma gondii DNA OU. Clindamycin (1.0 mg/0.1 mL) was injected bilateral intravitreal OU twice at 4 days apart with subsequent resolution of retinochoroiditis.ConclusionsWhen evaluating retinochoroiditis in an immunocompromised patient, one must keep a high index of suspicion for atypical presentations of well-known disease entities. Aqueous and vitreous samples for PCR can be useful in obtaining an accurate diagnosis and therefore provide appropriate management for the patient. Intravitreal clindamycin is an option for treatment in these patients.
Highlights
Toxoplasma retinochoroiditis can have an atypical presentation and be difficult to diagnose in immunocompromised patients
Summary statement An immunocompromised patient presented with floaters and fundus lesions suspicious for infectious retinochoroiditis vs. chronic myelogenous leukemia (CML) relapse
Despite negative serum toxoplasmosis titers, an aqueous polymerase chain reaction (PCR) analysis revealed ocular toxoplasmosis bilaterally and the patient responded to therapy
Summary
Toxoplasmosis should be included in the differential diagnosis of a retinochoroiditis in an immunocompromised patient even if it presents without the typical inflammatory response, an adjacent chorioretinal scar, typical retinitis, or is bilaterally active. If the CSF and serum serologies are negative, this should not sway the diagnosis away from toxoplasmosis in the immunocompromised patients. One should consider an aqueous tap for PCR analysis to aid in the diagnosis of the disease process. Once the diagnosis is confirmed, appropriate therapy may be promptly instituted in hopes of preserving the maximal vision. Competing interests The authors declare that they have no competing interests. RP, DL, UM, and DG all played a role in clinical diagnosis and treatment decision making as well as editing the manuscript. All authors read and approved the final manuscript
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
