Acute acquired toxoplasmic retinochoroiditis in a patient with anterior uveitis, amplified by immunosuppressive therapy

Abstract

A 24-year-old immunocompetent man with anterior uveitis developed a bilateral multifocal retinochoroiditis after an acute febrile multisystemic illness. Because of his history of idiopathic uveitis the multisystemic illness was treated with oral prednisone. When a retinochoroiditis occurred cyclosporine was added. This was followed by an extensive flare-up of the retinochoroiditis. The diagnosis of toxoplasmosis was then established by a positive polymerase chain reaction (PCR) from aqueous humour and confirmed by isolation of the parasite in several organs. On the base of kept frozen sera the acute febrile episode was found to be an acquired toxoplasmosis. On re-examination all evidence of pre-existing Fuchs' uveitis was gathered. The immunosuppressive therapy was discontinued and the patient was kept under anti-toxoplasmic maintenance therapy for 1 year without recurrence of the retinochoroiditis. The case illustrates a possible consequence of immunosuppressive therapy in infection with toxoplasmosis and the importance of the diagnosis of a pre-existing noninfectious uveitis.