Submacular Parasite Masquerading as Posterior Pole Granuloma

Abstract

Parasites enter the eye through hematogenous spread. The interaction with host immune system may result in its destruction but not without collateral damage to the vital retinal structures. Currently, the accepted treatment for ocular parasitosis is surgical removal or direct laser photocoagulation. A 24-year-old Indian woman presented with abrupt painless loss of vision to 5/300. A large yellow-white lesion centered at macula was observed with associated retinal and subretinal hemorrhage and neurosensory retinal detachment. A parasite was seen protruding at the center of the lesion. Fluorescein angiography demonstrated disc leakage and vessel wall staining. Ultrasonography demonstrated a highly reflective subretinal lesion with aftershadowing. Serological test was positive for anti-cysticercus (IgM) antibody. Treatment with prednisolone and albendazole resulted in resolution of the lesion within 2 months with improvement of visual acuity to 20/400. A noncystic form of subretinal cysticercosis is likely with suggestive B-scan ultrasonography and serological investigations.

Clinicopathological study of parasitic lesions of the eye and ocular adnexa in a tertiary care ophthalmic center in South India

“…Cases of submacular parasite masquerading as posterior pole granuloma have been reported. [ 14 ] Rarely, a degenerated cysticercus cyst with chronic inflammation may simulate endogenous endophthalmitis. [ 15 ] It can also present as fibrinous anterior uveitis with secondary glaucoma.…”

“…Our study showed that parasitic lesions can produce severe acute inflammation of the surrounding tissue which can masquerade an inflammatory mass[ 8 14 15 ] since most of the ocular signs are not specific and a high index of suspicion is required for clinical diagnosis. Careful search for the parasite should be done in all nodular and cystic lesions of the eye.…”

Submacular Cysticercosis Successfully Treated through Conservative Management: Case Report

“…The vision in his right eye was 20/25 30 months after presentation, and the uveitis was quiescent without further treatment [ 13 ]. Singh and Singh [ 14 ] reported the case of a 24-year-old female who presented with abrupt loss of vision in the right eye of 1 week duration. Best-corrected visual acuity was 5/300 OD and 20/20 OS.…”

Update on pathology of ocular parasitic disease

“…Cases of submacular parasite masquerading as posterior pole granuloma have been reported. [29] Rarely, a degenerated cysticercus cyst with chronic inflammation may simulate intravitreal infection. [30] It can also present as fibrinous anterior uveitis with secondary glaucoma; the uveitis resolves with removal of the cyst.…”