Unilateral optic neuritis as the presenting symptom of human immunodeficiency virus toxoplasmosis infection*

Abstract

the Department of Optic Neuritis with symptoms of optic neuritis (ON) in the right eye. The initial symptom was subacute blurred vision in the right eye. He complained of retrobulbar pain in the right eye with worsening on eye movements. An intermittent headache behind the right eye had begun 8 months previously. The pain was characterized as a shortlasting, shooting pain that worsened on stress and was relieved on resting. He denied previous infections, rashes and neurological signs. Six years earlier he was diagnosed with central serous chorioretinopathy with pigment epithelium detachment in the right eye and was treated with good visual outcome. He had visited Thailand 11⁄2 years earlier. Two and a half weeks later, visual acuity was light perception in the right eye and 1.0 in the left eye. Ophthalmological examination revealed right relative afferent pupillary defect, normal intraocular pressure, clear anterior segment and vitreous, and normal appearing fundus in both eyes except from laser scars in the right eye. Neurological examination revealed no additional findings, optical coherence tomography was normal and visual evoked potential showed delayed latency in the right eye (182 ms; 18 mm checks), normal findings in the left eye. Cerebrospinal fluid (CSF) showed pleocytosis (21 · 10 cells ⁄ l), increased IgG-index (1.19) and no oligoclonal bands. An extensive investigation of blood was normal, including Wasserman Reaction. Magnetic resonance imaging (MRI) showed 12 lesions suggestive of multiple sclerosis (MS) (Fig. 1).