Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary
            referral center in Turkey

Şimşek, Mert; Özdal, Pınar

doi:10.5935/0004-2749.20190058

Cited by 9 publications

(14 citation statements)

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“…Arcuate, altitudinal, or central visual field permanent scotomas indicative of papillary involvement had persisted in our patient after treatment. 8,9 The post-treatment persistence of these scotomas is thought to be due to remaining full-thickness optic disc atrophy despite the resolution of the active lesion. 9 A relative afferent pupillary defect, which was also highlighted in our patient, supported the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The post-treatment persistence of these scotomas is thought to be due to remaining full-thickness optic disc atrophy despite the resolution of the active lesion. 9 A relative afferent pupillary defect, which was also highlighted in our patient, supported the diagnosis. 5 Moreover similarly in our patient, a paramacular inferior retinochoroiditis scar in the unaffected eye was suggestive of recurrent toxoplasmosis in the affected eye.…”

Section: Discussionmentioning

confidence: 99%

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Toxoplasma papillitis without vitritis. A case report in an immunocompetent Congolese patient

Ngoma

Detry-Morel

Kayembe

2019

Germs

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Introduction Unilateral papillitis and neuroretinitis are uncommon manifestations of ocular Toxoplasma gondii infection and pose particularly challenging diagnosis problems. Due to the limited accessibility of healthcare and poor socioeconomic status of a significant proportion of the population in Democratic Republic of the Congo, knowledge of seroprevalence rates for toxoplasmosis remains key to the health system. When Toxoplasma papillitis or neuroretinitis is suspected, vitreous inflammatory reaction is usually present at various degrees on the initial examination as a diagnosis clue. Case report We report the case of a 37-year-old Congolese man who was managed in the University Hospital of Kinshasa, DR Congo, between October 2017 and April 2019 (18 months). The patient's informed consent was obtained for publication of his data. The patient developed presumed Toxoplasma papillitis with complete absence of vitritis at presentation. He was in good general health and had a known contact with a cat. Ophthalmoscopic examination revealed unilateral inflammation in the left optic disc and peripapillary area coexisting with active juxtapapillary retinochoroiditis that could be confirmed in ocular coherence tomography. A retinochoroiditis scar was present in the right eye. Left visual field was severely altered in automated perimetry. Toxoplasma titer was positive. Anti-HIV (ELISA) antibodies were negative. Rapid and favorable response to appropriate antiparasitic agents was observed without recurrence. Absence of vitritis and retinochoroiditis scar were confirmed during all the follow-up period. Conclusions Papillary toxoplasmosis is rare and potentially serious. Its diagnosis must be sought, even in the absence of vitritis, before taking into account any unilateral papillary edema. Our case report highlights the importance of detailed history and clinical examination to improve diagnostic decision making such as the need for complementary investigations, especially serologic testing, in a country with relatively limited financial resources in public health.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Toxoplasma papillitis without vitritis. A case report in an immunocompetent Congolese patient

Ngoma

Detry-Morel

Kayembe

2019

Germs

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“…In all three patients visual acuity improved after treatment, but to different extents likely due to the difference in macular involvement. Indeed, the increase in visual acuity after treatment is known to differ among the different types of papillitis, with the difference being driven more by macular than optic nerve involvement [15]. This is supported for instance by observations from previous studies that improvement in visual acuity is often greater in pure papillitis than in papillitis with concurrent chorioretinal lesions [6,15].…”

Section: Discussionmentioning

confidence: 87%

“…In fact, optic nerve involvement in OT may present in various forms, namely contiguous to a juxtapapillary chorioretinitis, neuroretinitis, pure papillitis, distant to an active chorioretinitis lesion, and various combinations of these. [15] When optic nerve is affected without any chorioretinal scar or active lesion, asserting the diagnosis OT-related papillitis based on clinical ground alone can be challenging, but serologic tests may provide evidence of exposure to the parasite [15]. In these two patients serum IgG and/or IgM toxoplasma antibodies were elevated, allowing to suspect toxoplamosis as the cause of the disc swelling.…”

Section: Discussionmentioning

confidence: 99%

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Papillitis and Neuroretinitis as Atypical Presentations of Ocular Toxoplasmosis

Kabedi¹,

Mwanza²

2021

Preprint

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We report three cases of optic nerve toxoplasmisis, an unusual form of ocular toxoplasmosis. In one patient the optic nerve involvement occurred in an eye with a toxoplasmic chorioretinal scar and choroidal neovessels in the supramacular area, subretinal fibrosis, and pigment epitheium detachment. The other two patients had papilledema without healed or active chorioretinal lesions, but both had retinal hemorrhage and macular involvement. The diagnosis was based on clinical examination and elavated serum toxoplama antibodies. Optical coherence tomography helped uncover the structural chorioretinal changes. All three patients were treated with a combination of oral antitoxoplasmic drugs, oral prednisone, and intravitreal injection of bevacizumab. Visual acuity improved in all of them. Optic nerve involvement in ocular toxoplasmosis must be considered when papilledema occurs both in isolation and in the presence of an active or scarred chorioretinal lesion.

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Bilateral optic neuritis with spine demyelination associated with influenza A H1N1 infection

Selvakumar

Lakshmi

Noronha

2020

American Journal of Ophthalmology Case Reports

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Purpose To report a rare case of optic neuritis with spine demyelination following H1N1 virus infection. Observation A 66-year-old female presented with decreased vision in both eyes (left > right) following a recent episode of fever and flu. She was diagnosed as H1N1 infection confirmed by viral antigen analysis of throat swab. On examination, she had a profound vision drop in the left eye with optic disc edema. MRI brain and orbit revealed bilateral optic nerve and frontal dural thickening with a ring-enhancing lesion in the right frontal lobe. MRI spine showed long cord signals at T1-T7 suggestive of demyelination. The patient had a complete recovery of vision and visual fields after intravenous and oral steroids. Conclusion/Importance Influenza A virus can manifest with a wide range of symptoms including flu-like illness to neurological complications. This case highlights optic neuritis as a presenting feature of H1N1 infection.

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Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary referral center in Turkey

Cited by 9 publications

References 0 publications

Toxoplasma papillitis without vitritis. A case report in an immunocompetent Congolese patient

Toxoplasma papillitis without vitritis. A case report in an immunocompetent Congolese patient

Papillitis and Neuroretinitis as Atypical Presentations of Ocular Toxoplasmosis

Bilateral optic neuritis with spine demyelination associated with influenza A H1N1 infection

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