Atypical Forms of Ocular Toxoplasmosis in Childhood. A Case Report

Abstract

Aim: To present an outline of acquired atypical forms of ocular toxoplasmosis (OT) in childhood, with reference to the 100th anniversary of the discovery of this etiology by Professor Janků from Czechoslovakia, who was first to describe the clinical congenital picture of OT characterised by macular scar. Material and Methods: Symptoms of intraocular bilateral neuritis appeared in a 6-year-old girl, with visual acuity (VA) bilaterally 0.1. Toxoplasmic etiology was demonstrated in laboratory tests, and the patient was immunocompetent. Following treatment with macrolide antibiotic and parabulbar application of corticosteroid, the condition was normalised stably at VA 1.0 in both eyes. Bilateral retinal vasculitis was determined in an 8-year-old boy, with VA of 0.25 in the right eye and 0.25 in the left, with a medical history of strabismus detected after suffering from varicella. The examination for toxoplasmosis was negative, but pronounced general hypogammaglobulinaemia classes IgG, IgM and IgA was detected. Immunosuppressive and immunomodulatory therapy did not produce the desired effect, and the condition progressed to retinochoroiditis. Due to blindness and dolorous glaucoma, enucleation of the right eye was performed at the age of 15 years. Histologically toxoplasmic cysts with bradyzoites were detected, a subsequent laboratory test demonstrated toxoplasmic etiology upon a background of persistent regressing hypogammaglobulinaemia. General anti-toxoplasma and subsequent immunosuppressive treatment did not produce the desired effect, and at the age of 22 years the patient lost his sight also in the left eye. Conclusion: Atypical form of OT intraocular neuritis in an immunocompetent patient had a favourable course, whereas retinal vasculitis with retinochoroiditis in a temporarily immunocompromised patient ended in bilateral blindness.

Who Let the Dogs Out ? Unmasking the Neglected : A Com-prehensive Review on the Enduring Impact of Toxocarosis, a Prevalent Zoonotic Infection

“…Ocular larval migrans (OLT) is a syndrome mainly affecting older children, adolescents, and adults, and shows clinical diversity, partly reflecting the age of the affected individual [32,[110][111][112]. Ocular disease is associated to the migration of the parasites through the circulation into the posterior eye segment with subsequent local release of inflammatory responses [95,111].…”

“…Ocular disease is associated to the migration of the parasites through the circulation into the posterior eye segment with subsequent local release of inflammatory responses [95,111]. The most prevalent form of the disease is the development of peripheral granuloma of the eye followed by granuloma of the posterior pole of the eye, commonly extending from the macular landscape to the central retinal periphery and is always accompanied by vitritis [112]. The disease occurs more frequently unilateral; however, bilateral ocular infestation has also been described [111].…”

“…Children can also develop leukocoria, strabismus, photophobia, eye pain, or eye redness [32]. Moreover, in pediatric patients, OLT may be also manifested as optic nerve neuropathy, fulminant endophthalmitis or papillitis with or without glaucoma, and rarely as diffuse chorioretinitis due to migration of dying larvae [12,112].…”