Toxoplasmosis chorioretinitis mimicking acute retinal necrosis associated with local corticosteroid

Jason N Crosson,Steven Yeh,Philip W Laird,Cindy S Hwang,Hans E Grossniklaus,Jessica G Shantha,Sanjana Kuthyar,Matthew R Debiec

doi:10.1186/s40942-020-00225-0

Jason N Crosson, Steven Yeh + Show 6 more

Open Access

https://doi.org/10.1186/s40942-020-00225-0

Copy DOI

Abstract

BackgroundThe cases discussed highlight the atypical presentation and diagnostic dilemmas of toxoplasmosis with fulminant retinal necrosis and the potentially devastating visual outcomes of toxoplasma chorioretinitis following local corticosteroid exposure.Case presentationWe report a series of three patients who presented with toxoplasmosis mimicking severe acute retinal necrosis. Patients were between 59 and 77 years old and had been exposed to local corticosteroids preceding our evaluation. All patients demonstrated diffuse retinal whitening with severe vision loss on presentation. Polymerase chain reaction testing (PCR) was diagnostic in two patients, and histopathologic examination of a vitrectomy specimen was diagnostic in one patient. All cases of retinitis resolved with anti-parasitic medication; however, visual acuity failed to improve in all patients due to disease severity and presentation.ConclusionsLocal corticosteroid injection may trigger or exacerbate toxoplasmosis chorioretinitis, leading to fulminant retinal necrosis and severe vision loss. Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, particularly following local corticosteroid injection regardless of their baseline systemic immune status. Diagnostic vitrectomy may be helpful in patients in whom PCR testing is negative and ocular toxoplasmosis is suspected.

Highlights

Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, following local corticosteroid injection regardless of their baseline systemic immune status
Diagnostic vitrectomy may be helpful in patients in whom Polymerase chain reaction testing (PCR) testing is negative and ocular toxoplasmosis is suspected
Ocular toxoplasmosis is a common cause of infectious uveitis that most commonly presents with unilateral retinitis adjacent to a chorioretinal scar; systemically immunosuppressed individuals may present with atypical lesions consisting of large areas of retinal necrosis without adjacent retinal scarring [1, 2]

Summary

Conclusions

Local corticosteroid injection may trigger or exacerbate toxoplasmosis chorioretinitis, leading to fulminant retinal necrosis and severe vision loss. Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, following local corticosteroid injection regardless of their baseline systemic immune status. Diagnostic vitrectomy may be helpful in patients in whom PCR testing is negative and ocular toxoplasmosis is suspected

Introduction

Discussion

Conclusion