Atypical presentation of ocular toxoplasmosis: A Case report of exudative retinal detachment and choroidal Ischemia

Alzahrani, Yahya; Al-Dhibi, Hassan; Al-Abdullah, Abdulelah A.

doi:10.4103/0974-9233.164624

Cited by 7 publications

(8 citation statements)

References 6 publications

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“…The first red flag was the presence of an extensive retinal detachment with tractional bands surrounding the central scar and no responsible break which could be suggestive of tractional and/or exudative retinal detachment in our case. Although tractional, exudative, and rhegmatogenous retinal detachments can occur in ocular toxoplasmosis, such reports are limited; the reported prevalence of retinal detachment in acquired toxoplasmosis varies between 2.5 and 11 percent which is mostly of tractional or rhegmatogenous type [ 13 , 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis

Pour

Riazi-Esfahani

Ebrahimiadib

et al. 2021

Case Reports in Ophthalmological Medicine

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Background. The aim is to report an atypical presentation of ocular toxoplasmosis which led to the diagnosis of Acquired Immunodeficiency Syndrome (AIDS). Case Report. The 38-year-old woman was referred with metamorphopsia and reduced vision in the right eye over the past 3 weeks. Slit-lamp examination revealed granulomatous keratic precipitates (KPs), 2+ cells in the anterior chamber, and posterior synechiae. Fundus examination was remarkable for a white patch surrounding a scar, inferonasal to the optic disc with fibrous bands emanating from the lesion, and the retina around this region was detached with considerable extension towards the periphery, while no breaks could be appreciated. She mentioned anorexia and losing 10 kg in the past three months, and signs of anemia like paleness of face skin, bed nails, and bilateral angular cheilitis were observed on systemic evaluation. The results of the patient’s complete blood count revealed anemia and leukopenia and CD4 lymphocytes: 79 cells/μL. Enzyme-linked immunosorbent assays (ELISA) for HIV antibodies came back positive which was later confirmed with the Western blot test. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices. The patient underwent antitoxoplasmosis and anti-HIV treatment and serous retinal detachment completely resolved. Conclusion. This report highlights the fact that sometimes, the eyes are the site of the first presentation of a systemic life-threatening condition and emphasizes the role of ophthalmologists in such cases. In cases of atypical presentation, appropriate laboratory tests and CNS imaging should be requested. Systemic treatment with antitoxoplasmosis regimens and highly active antiretroviral therapy (HAART) is mandatory in AIDS patients with ocular toxoplasmosis.

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Section: Discussionmentioning

confidence: 99%

“…In another study, Al-Zahrani et al reported a 24-year-old man with exudative RD secondary to reactivation of a toxoplasmosis lesion, which was successfully managed with antitoxoplasmosis treatment [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis

Pour

Riazi-Esfahani

Ebrahimiadib

et al. 2021

Case Reports in Ophthalmological Medicine

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“…[13] In another study, Al-Zahrani et al reported a 24-year-old man with exudative RD secondary to reactivation of a toxoplasmosis lesion, which was successfully managed with anti-toxoplasmosis treatment. [11] In a study by Faridi et al, on thirty-ve eyes of 28 patients with ocular toxoplasmosis and su cient followup, they identi ed 4 eyes (11 percent) with secondary RD, which was either rhegmatogenous, tractional, or a combination of the two. All eyes with retinal detachment underwent surgical repair of which 50% developed recurrent RDs (two of 4 patients).…”

Section: Discussionmentioning

confidence: 99%

“…[ [10][11][12][13] Angular cheilitis and signi cant weight loss, are not expected to occur in typical ocular toxoplasmosis. The presence of angular cheilitis calls for investigating the possibility of anemia and its underlying etiology.…”

Section: Discussionmentioning

confidence: 99%

Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis: a Case Report

Pour¹,

Riazi-Esfahani²,

Ebrahimiadib³

et al. 2021

Preprint

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Background: The aim is to report an atypical presentation of ocular toxoplasmosis which led to the diagnosis of Acquired Immunodeficiency Syndrome (AIDS). Case report: The 38-year-old woman was referred with metamorphopsia and reduced vision in the right eye in the past 3 weeks. Slit-lamp examination revealed granulomatous keratic precipitates (KPs), 2+ cells in the anterior chamber, and posterior synechiae. Fundus examination was remarkable for a white patch surrounding a scar, inferonasal to the optic disc with fibrous bands were emanating from the lesion and the retina around this region was detached with considerable extension towards periphery, while no breaks could be appreciated. She mentioned anorexia and losing 10 kg in the past three months and bilateral angular cheilitis was observed on systemic evaluation. The results of the patient's complete blood count revealed bicytopenia and CD4 lymphocytes: 79 cells/µl. Enzyme-linked immunosorbent assays (ELISA) for HIV antibodies came back positive which was later confirmed with the Western-blot test. Brain Magnetic Resonance Imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices. Patient underwent Anti-Toxoplasmosis and Anti-HIV treatment and serous retinal detachment was completely resolved. Conclusion: This report highlights the fact that sometimes the eyes are the site of the first presentation of a systemic life-threatening condition and emphasizes the role of ophthalmologists in such cases. In cases of atypical presentation, appropriate laboratory tests and CNS imaging should be requested. Systemic treatment with anti-toxoplasmosis regimens and HAART is mandatory in AIDs patients with ocular toxoplasmosis.

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“…In most cases, retinal lesions are sufficiently characteristic to allow an OT diagnosis to be established by ophthalmologists relying only on ophthalmic examination (5). However, the clinical presentation can at times prove to be misleading, requiring biological tests to be either confirmed or refuted (5–8). Indeed, a recent article showed that, in South America, the clinical diagnosis could be modified in a significant proportion of uveitis cases when adding laboratory testing (9).…”

Section: Introductionmentioning

confidence: 99%

Biological Diagnosis of Ocular Toxoplasmosis: a Nine-Year Retrospective Observational Study

Greigert

Pfaff

Sauer

et al. 2019

mSphere

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Ocular toxoplasmosis (OT), i.e., the ocular manifestation of Toxoplasma gondii infection, is one of the leading causes of posterior uveitis. While ocular lesions are often typical, atypical forms often require biological confirmation of the diagnosis. Our study sought to review the biological OT diagnoses made in our laboratory to further assess the role of each test in the diagnostic procedure. All ocular samples sent to our laboratory over the last 9 years for OT diagnosis were included. These samples were analyzed using T. gondii PCR and antibody detection by means of immunoblotting and Candolfi coefficient (CC) determinations, either alone or in combination. Since serum analysis is required to interpret both the CC and immunoblotting, blood serology for T. gondii was also performed in most cases. Of the 249 samples analyzed, 80 (32.1%; 95% confidence interval [95%CI], 26.3 to 37.9) were positive for OT. Of these 80 cases, 52/80 (65.0%; 54.6 to 74.5) displayed a positive PCR, 15/80 (18.8%; 10.2 to 27.3) a positive CC, and 33/80 (41.3%; 95%CI, 30.5 to 52.0) a positive immunoblot result. Overall, 63 of the 80 OT diagnoses (78.8%; 95%CI, 69.8 to 87.7) were made on the basis of a single positive test result. Our study results remind us that current biological diagnostic tools for OT must be employed in combination to obtain an optimal diagnosis based on the precious ocular fluids sampled by ophthalmologists. Clinicobiological studies that are focused on correlating the performances of the different tests with clinical features are critically needed to improve our understanding of the pathophysiology and diagnosis of OT. IMPORTANCE Ocular toxoplasmosis (OT), a parasitic infection of the eye, is considered to be the most important infectious cause of posterior uveitis worldwide. Its prevalence is particularly high in South America, where aggressive Toxoplasma gondii strains are responsible for more-severe presentations. The particular pathophysiology of this infection leads, from recurrence to recurrence, to potentially severe vision impairment. The diagnosis of this infection is usually exclusively based on the clinical examination. However, the symptoms may be misleading and are not always sufficient to confirm a diagnosis of OT. In such cases, biological tests performed by means of several techniques on blood and ocular samples may facilitate the diagnosis. In this study, we analyzed the tests that were performed in our laboratory over a 9-year period every time OT was suspected. Our report highlights that the quality of ocular sampling by ophthalmologists and combinations of several techniques are critical for a reliable biological OT diagnosis.

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Atypical presentation of ocular toxoplasmosis: A Case report of exudative retinal detachment and choroidal Ischemia

Cited by 7 publications

References 6 publications

Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis

Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis

Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis: a Case Report

Biological Diagnosis of Ocular Toxoplasmosis: a Nine-Year Retrospective Observational Study

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