SCIENTIFIC POSTER 2016_A Case of Ocular Toxoplasmosis Presenting as Unilateral Papillitis and Juxtapapillary Retinitis Kuihyung Mun

Purpose:

Toxoplasmic retinochoroiditis is the most common form of posterior uveitis in otherwise healthy individuals. Papillitis and complicating acute juxtapapillary retinitis, are unusual and atypical features of ocular toxoplasmosis. This report presents an atypical case of ocular toxoplasmosis presenting as unilateral papillitis and juxtapapillary retinitis.

Case summary:

A 48-year-old man presented with a 1-week history of red eye, photophobia, eyeball pain, and decreased visual acuity of the left eye. Best corrected visual acuity was 20/200 in the left eye and 20/20 in the right eye. There were mild cellular reactions in the anterior chambers and vitreous humors in his left eye. On fundoscopic examination, marked optic disc swelling and juxtapapillay whitish-yellow inflammatory lesion, near an atrophic retinochoroidal scar located between optic disc and macula, were found in his left eye. Fluorescein angiography revealed marked leakage of dye from the swollen optic disc. There was no evidence of vasculitis. Optical coherence tomography (OCT) revealed left optic disc swelling, cysoid macular edema, and retinal pigment epithelial atrophy. Pupillary light reflex and color vision were normal. Serologic assessment was negative for IgM to toxoplasma gondii, but serum IgG to toxoplasma gondii was elevated (421.4 IU/mL; reference value <1.0 IU/mL). A complete blood count revealed no abnormalities. A shyphilis evaluation and other tests which were toxocariasis and rheumatologic tests were negative. A presumptive diagnosis of toxoplasmic papillitis and juxtapapillary retinitis were made. After two months of treatment of trimethoprim/sulfamethoxazole (960 mg/day) and oral predinisolone (30 mg/day), disc swelling and juxtapapillary retinal lesion were resolved. The patient’s left-eye visual acuity had improved from 20/200 to 20/100.

Conclusions:

Ocular toxoplasmosis can present atypically as papillitis and juxtapapillary retinitis, even when peripheral retinal scars are absent. In selected, atypical cases, ocular toxoplasmosis should be included as a differential diagnosis of unilateral disc swelling. Proper treatment should be performed thorough serologic examination for toxoplasmosis.

Contact Details:

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Kuihyung Mun