Isolated unilateral disk edema

Varner, Paul

doi:10.2147/opto.s22806

Cited by 1 publication

(2 citation statements)

References 544 publications

(502 reference statements)

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“…(3)(4)(5) However, there is no uniform terminology for papillary alteration, and its various designations, including papilledema (resulting from intracranial hypertension), papillitis, papillopathy, papilloretinitis, neuroretinitis, and optic disc edema, may hinder comparisons. (6) Regarding etiology, viral, bacterial, fungal and parasitic infections, including toxoplasmosis, can trigger the onset of optic disc edema. (6) However, papillitis must be differentiated from other etiologies, such as ischemic anterior optic neuropathy, intraorbital compression, and central nervous system lesions and infections.…”

Section: Introductionmentioning

confidence: 99%

“…(6) Regarding etiology, viral, bacterial, fungal and parasitic infections, including toxoplasmosis, can trigger the onset of optic disc edema. (6) However, papillitis must be differentiated from other etiologies, such as ischemic anterior optic neuropathy, intraorbital compression, and central nervous system lesions and infections. (7) Papillitis alone due to toxoplasmosis is an uncommon finding; it was found in 5.9% of patients in a study conducted in southern Brazil, (3) 2.9% in a study in Congo (5) and 2% in a study in Japan.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Uncommon progression of toxoplasmic papillitis: patient perception and case report

Bonamigo¹,

Rossi²,

Rosa³

et al. 2021

Revista Brasileira De Oftalmologia

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Ocular toxoplasmosis frequently presents as necrotizing retinochoroiditis and, less often, as peripapillary chorioretinitis and/or papillitis. The progression from papillitis to peripapillary retinochoroiditis has been rarely described. We report the case of a 52-year-old patient living in southern Brazil, who developed papillitis in the right eye and was treated with systemic corticosteroids (prednisone 0.6 mg/kg/day and pulse therapy with methylprednisolone 15 mg/kg/day, for 3 days). After 14 days, the patient developed peripapillary retinochoroiditis with vitritis and decreased visual acuity (20/60), and was immediately initiated on the classic oral treatment for toxoplasmosis, consisting of pyrimethamine (50 mg/day), sulfadiazine (4 g/day), folinic acid (15 mg every 3 days) and prednisone (0.6 mg/kg/day). The visual acuity of the right eye normalized after treatment (20/20), which lasted approximately 70 days, but scotomas were detected on visual field examination, especially in the lower nasal quadrant. Although two studies mentioned this presentation, our report emphasizes the possible manifestation of ocular toxoplasmosis as papillitis in the initial phase, with progression to peripapillary retinochoroiditis and permanent visual field defects, which justifies early treatment for toxoplasmosis in suspected cases, especially in endemic regions. RESUMOA toxoplasmose ocular manifesta-se com maior frequência por um quadro de retinocoroidite necrotizante e, com menor frequência, por coriorretinite justapapilar e/ou papilite. A evolução de papilite para retinocoroidite justapapilar raramente foi descrita. Apresenta-se o relato de caso de uma paciente de 52 anos, habitante da Região Sul do Brasil, que iniciou com quadro de papilite em olho direito, sendo tratada com corticoides sistêmicos (prednisona 0,6/mg/kg ao dia e pulsoterapia com metilprednisolona 15mg/kg ao dia, por 3 dias), mas, após 14 dias, evoluiu para retinocoroidite justapapilar, com vitreíte e diminuição de acuidade visual (20/60), sendo imediatamente instituído o tratamento via oral clássico para toxoplasmose, com pirimetamina (50 mg ao dia), sulfadiazina (4 g ao dia) e ácido folínico (15 mg a cada 3 dias), e mantida a prednisona (0.6 mg/kg/dia). A acuidade visual do olho direito normalizou após o tratamento (20/20), que durou em torno de 70 dias, porém desenvolveu escotomas ao exame de campo visual, sobretudo de quadrante nasal inferior. Embora tenham sido encontrados dois trabalhos que mencionam essa forma de apresentação, o presente relato destacase por enfatizar a possibilidade de manifestação da toxoplasmose ocular por meio de papilite na fase inicial, que evolui com retinocoroidite justapapilar, causando defeito permanente de campo visual, justificando que se avalie a instituição de tratamento precoce para toxoplasmose dos casos suspeitos, sobretudo em região endêmica.

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