Neuroretinitis and Juxtapapillary Retinochoroiditis as Atypical Presentations of Ocular Toxoplasmosis

Kabedi, Nelly N.; Mwanza, Jean-Claude

doi:10.2147/imcrj.s332147

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…In most cases with ocular Toxoplasmosis , a classic fundus examination showed a chorioretinitis, characterized by being an atypical inflammatory yellow-white, round, single lesion of approximately an optic disc in diameter. [ 6 , 7 ] The serology test detected anti- T gondii IgG positive. Since the serum antibody level of patients with T gondii retinochoroiditis is generally low, and the level of antibody has no significant correlation with the severity of fundus lesions, [ 8 ] therefore, any serum anti-toxoplasma antibody positive regardless of the titer, as long as it is combined with typical fundus lesions diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Antibodies against Toxoplasma gondii positive in serum and aqueous humor to diagnose clinically suspected ocular toxoplasmosis: A case report

Niu

Wang

et al. 2022

Medicine

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Introduction: Previously, diagnosis of ocular toxoplasmosis is based on clinical symptoms and Toxoplasma serology. Checking serological indicators often cannot reflect the real intraocular situation, and may even mislead clinicians to make wrong judgments.Patient concerns: A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of decreased vision for about 5 days in his right eye.Diagnosis: Aqueous humor sample analysis found Toxoplasma DNA detectable, and Toxoplasma immunoglobulin G (IgG) and immunoglobulin M (IgM) to be positive. His serum Toxoplasma IgG was also positive (10.04 IU/mL; reference range: 0 to 7.2 IU/ mL). Therefore, the final diagnose was ocular toxoplasmosis involving his right eye.Interventions: Oral prednisone 60 mg/day and azithromycin 0.25 g/day were started. Oral antibiotic treatment for toxoplasma was continued for 4 weeks, and prednisone followed by weekly stepwise tapering in steps of 10 mg/day.Outcomes: The BCVA and fundus of right eye remained stable after treatment at follow-up.Conclusions: This article reported a case of ocular Toxoplasma gondii infection diagnosis by serum and aqueous humor antibody tests. We provide some additional information on the T gondii infection diagnosis.

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Section: Discussionmentioning

confidence: 99%

Antibodies against Toxoplasma gondii positive in serum and aqueous humor to diagnose clinically suspected ocular toxoplasmosis: A case report

Niu

Wang

et al. 2022

Medicine

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“…In several studies published in literature, the authors describe choroidal neovascularization in the area of the chorioretinal cicatrix [6] [14] [15]. It is thought to be the result of retinal vessel endothelial cells being preferred by the toxoplasma tachyzoite.…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications of toxoplasma chorioretinitis are: cystoid macular edema and vasculitis, less often occlusion of arterioles or venules [6]. The involvement of retinal vessels in the disease results from the production and deposition of antigen-antibody complexes in the vessel walls, as well as sectoral mononuclear cell infiltration.…”

Section: Introductionmentioning

confidence: 99%

Ischemic Retinal Vasculitis after Previous Toxoplasma Chorioretinitis

Mitkova-Hristova¹,

Stoyanova²

2022

OJOph

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Introduction: Ischemic retinal vasculitis is an inflammatory disease affecting the retinal vessels. Visual acuity decreases due to macular ischemia, macular edema, neovascularization leading to vitreous hemorrhage, fibrovascular proliferation or tractional retinal detachment. Purpose: To present the case of a patient with ischemic retinal vasculitis. Material and Methods: The case involves a 34-year-old woman. The following tests were performed: complete blood count, biochemistry, coagulogram, rheumatological tests, serum calcium level, angiotensin-converting enzyme, CT of the lungs, MRI of the brain and spine, serological tests for: cytomegalovirus, herpes simplex virus (type 1 and 2), varicella-zoster virus, toxoplasmosis, tuberculosis, syphilis, as well as fluorescein angiography and optical coherence tomography. Results and Discussion: The patient was admitted to the hospital with visual acuity of the right eye, 0.8/0.9, and of the left eye, 1.0. The intraocular pressure in both eyes was normal: 14 mmHg in the right eye and 15 mmHg in the left eye. The following pathological finding was detected in the right eye fundus: an old chorioretinal cicatrix under the inferior temporal vascular arch with an ischemic exudate next to it, occlusion of the inferior temporal retinal arterial and venous branches, neovascularization and a preretinal hemorrhage. Fluorescein angiography showed delayed filling of the affected vessels, neovascularization, and major ischemia in the lower temporal part of the retina. The results of the serological tests for varicella zoster virus, herpes simplex virus type 1 and toxoplasmosis were outside the reference ranges. The patient was treated with Clindamycin and Acyclovir. Emergency laser therapy was performed in the ischemic retina area. Previous toxoplasma chorioretinitis was diagnosed, which had led to ischemic retinal vasculitis with sectoral involvement of the retinal vessels. The patient has been monitored over 3 -4 month periods, showing high visual acuity and stable ocular condition. Conclusion: Patients with ischemic retinal vasculitis are a challenge when it comes to cla-

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“…Acquired or congenital ocular toxoplasmosis [1], is a major cause of infectious posterior uveitis in immunocompetent patients [2], [3], whose severity is correlated with associated complications: macular edema, retinal detachment, retinal vascular occlusions and choroidal neovascularization [4].…”

Section: Introductionmentioning

confidence: 99%

Acute Neuro-Retinitis Secondary to a Recently Acquired Ocular Toxoplasmosis in a Young Immunocompetent Patient

Chafik,

Nado,

Ammar

et al. 2024

EJMED

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A 27-year-old male patient with no medical history presented with a painless unilateral vision loss in the right eye, counting fingers at 5 meters, with active vitreous inflammation, stage II papilledema, whitish lesion on the superior-temporal border of the optic disc and a poor macular reflex, without any active or scarring chorioretinal lesion in the periphery. Multimodal imaging showed intra- and subretinal macular edema with early hypo-fluorescence followed by progressive centripetal filling of the peripapillary lesion and finally papillary diffusion. The visual field revealed an inferotemporal defect. Blood work showed hyperleukocytosis with positive toxoplasma serology, the rest of the workup was negative, especially no immunosuppression. The diagnosis of toxoplasmic anterior optic neuropathy was made due to the papillary and peripapillary involvement without a distant active or scarring lesion, with positive toxoplasma IgG and IgM serology. Trimethoprim/sulfamethoxazole antibiotic treatment with systemic corticosteroid therapy was initiated in our patient with an excellent outcome, including restoration of visual acuity to 10/10, complete vitreous clearance, complete resolution of the papillary and macular edema, and the peripapillary lesion without visible scarring, but leaving a persistent defect of the corresponding retinal nerve fibers. This clinical case thus illustrates a toxoplasmic anterior optic neuropathy with direct papillary involvement complicated by macular edema, a rare and atypical clinical entity of ocular toxoplasmosis, especially in a young immunocompetent subject, reflecting the clinical polymorphism of this pathology.

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Neuroretinitis and Juxtapapillary Retinochoroiditis as Atypical Presentations of Ocular Toxoplasmosis

Cited by 6 publications

References 20 publications

Antibodies against Toxoplasma gondii positive in serum and aqueous humor to diagnose clinically suspected ocular toxoplasmosis: A case report

Antibodies against Toxoplasma gondii positive in serum and aqueous humor to diagnose clinically suspected ocular toxoplasmosis: A case report

Ischemic Retinal Vasculitis after Previous Toxoplasma Chorioretinitis

Acute Neuro-Retinitis Secondary to a Recently Acquired Ocular Toxoplasmosis in a Young Immunocompetent Patient

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