Abstract
Purpose :
Chorioretinitis is the most common presentation of ocular toxoplasmosis. Here we present a retrospective chart review of three uncommon presentations of ocular toxoplasmosis.
Methods :
Retrospective chart review. Case 1: 79 yo male presented with decreased visual acuity (VA) OD. On exam, VA OD was 20/80 and VA OS was 20/30. Ocular exam was normal except for diffuse leakage of both optic nerves on Fluorescein Angiography (FA). Case 2: 39 yo female. VA OD 20/30 and VA OS 20/20. Exam showed neuroretinitis of right eye with mild iritis. Case 3: 89 yo male with history of dry macular degeneration presented with decreased VA OS. Exam revealed neuroretinitis of left eye.
Results :
In all three cases, complete uveitis workup was negative except for toxoplasmosis. Case 1 was diagnosed with presumed papilledema and neurological workup was negative. A course of Bactrim DS for 2 months led to resolution of optic neuropathy. Case 2 was treated with oral Sulfadiazine/pyrimethamine and prednisone plus topical steroids and patient’s neuroretinitis resolved. However, 2 years later the patient presented with episcleritis of the right eye. FA showed diffuse leakage of optic nerve. Repeat of labs showed highly elevated IgG for toxoplasmosis. Pt was treated with oral Bactrim DS plus topical steroids which led to resolution of episcleritis and optic neuropathy. Case 3 was started on triple therapy (pyrimethamine, sulfadiazine, and corticosteroids). Patient eventually refused treatment due to the cost of pyrimethamine. Patient’s VA declined to 20/400. Patient was unable to receive Bactrim as he was on warfarin, so he was treated with 5 intraocular injections of clindamycin 1mg and 2 intraocular injections of dexamethasone 360mcg over a period of 8 weeks with total resolution of neuroretinitis. VA improved to 20/60.
Conclusions :
Although involvement of the optic nerve is an uncommon manifestation of ocular toxoplasmosis, it should remain in the differential diagnosis in patients who present optic neuritis or neuroretinitis because early recognition and appropriate treatment can effectively improve visual acuity.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.