Toxoplasmosis Neuroretinitis: A Case Report

Shoeibi, Nasser; Hosseini, Seyedeh Maryam; Bayani, Razie

doi:10.5812/ircmj.33115

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…In Iran, a patient with ocular toxoplasmosis whose initial presentation was papilledema with a macular star, which later progressed to a peripapillary lesion, and her visual acuity increased from 0.1 to 0.9 after specific treatment for toxoplasmosis. (11) The patient in this report did not present with a macular star but had significant vascular sheathing 44 days after the start of treatment, which partially regressed after the end of treatment. In New Zealand, similar to our case, two patients who first presented with ocular toxoplasmosis in the form of papillitis alone developed peripapillary retinochoroiditis after two weeks.…”

Section: Discussionmentioning

confidence: 59%

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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Section: Discussionmentioning

confidence: 59%

“…This form of progression was described in two recent studies conducted in New Zealand (8) and Iran. (11) However, those studies only mentioned its occurrence, and did not emphasize the importance of early recognition, especially in toxoplasmosis-endemic regions.…”

Section: Introductionmentioning

confidence: 99%

Uncommon progression of toxoplasmic papillitis: patient perception and case report

Bonamigo¹,

Rossi²,

Rosa³

et al. 2021

Revista Brasileira De Oftalmologia

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“…Toxoplasma neuroretinitis is known for a characteristic appearance of optic disc edema prior to appearance of stellate maculopathy with vitreous inflammation and peripheral chorioretinal scars [2,4]. The first sign of neuroretinitis was described as idiopathic stellate maculopathy with optic nerve edema with a previous onset of a viral like illness [1,3,5]. Although loss of vision due to toxoplasmosis commonly involves chorioretinitis, neuroretinitis is relatively rare, and toxoplasmosis should be included as part of the differential diagnosis with pertinent history and retinal signs of optic disc edema and possible later development of the macular star formation [2,6].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Overall, toxoplasma neuroretinitis has a favorable prognosis with most cases regaining good visual acuity [ 2 , 5 ]. In our case, enough suspicion from history and fundus exam which included a patch of adjacent chorioretinitis resulted in timely workup and diagnosis.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Toxoplasma Neuroretinitis

Hsu¹,

Uwaydat²,

Chacko³

2022

Case Rep Ophthalmol

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Neuroretinitis is an inflammatory condition with rapid unilateral vision loss, optic disc edema, and macular star formation. While neuroretinitis is commonly due to infectious causes such as <i>Bartonella henselae</i>, neuroretinitis due to toxoplasmosis is uncommon. A 29-year-old male presents to our neuro-ophthalmology clinic on December 7, 2021, at the University of Arkansas for Medical Sciences with symptoms of left eye pain and blurred vision. Subsequent workup led to the diagnosis and treatment of toxoplasma neuroretinitis. The fundus exam eventually demonstrated a notable macular star. Treatment was well tolerated, and the patient regained total visual acuity in the affected eye. Toxoplasma neuroretinitis is known for a characteristic appearance of optic disc edema prior to appearance of stellate maculopathy with vitreous inflammation and peripheral chorioretinal scars. Although loss of vision due to toxoplasmosis is rare, it should be included as part of the differential diagnosis with pertinent history.

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“…Ocular toxoplasmosis presenting as neuro-retinitis is very rare. [4] Case report A 45-year-old female presented to Ophthalmology clinic with sudden painless diminution of vision in left eye and inability to see the objects located inferiorly for the past ten days. There was no history of pain on eye movements, fever, headache, jaw claudication, focal neurological decit, contact with pets,sexual promiscuity, and travel to endemic areas of Lyme's disease.…”

Section: Introductionmentioning

confidence: 99%

Toxoplasma Neuro-Retinitis in an Immuno-Competent Adult- A Case Report and Review of Literature

Senthamizh

Kaliaperumal

2020

ijsr

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Toxoplasmosis is a protozoan parasitic infection caused by Toxoplasma gondii. It is transmitted congenitally or acquired in later stages of life either by ingestion of oocysts from cat’s feces attached or by eating under cooked meat. Ocular toxoplasmosis presents most commonly as posterior uveitis and rarely involves the optic nerve. We report a case of 45-year-old female, who is immuno-competent, presented with painless diminution vision in her left eye. Her best corrected vision was 6/36 in left eye and 6/6 in right eye. Examination of left eye revealed a clear media with optic disc swelling and hard exudates arranged in stellate fashion around the macula and inferior altitudinal field defects. Investigations revealed elevated titres of toxoplasma IgG antibody. Patient showed significant improvement with medical therapy. Since this neuroretinitis type of presentation in ocular toxoplasmosis is rare, awareness about this condition among clinicians can help prompt treatment and prevent significant blindness.

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Toxoplasmosis Neuroretinitis: A Case Report

Cited by 6 publications

References 7 publications

Uncommon progression of toxoplasmic papillitis: patient perception and case report

Uncommon progression of toxoplasmic papillitis: patient perception and case report

Toxoplasma Neuroretinitis

Toxoplasma Neuro-Retinitis in an Immuno-Competent Adult- A Case Report and Review of Literature

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