First Author: N.Berker TURKEY
Co Author(s): B. Ceran P. Ozdal 0 0 0 0 0 0 0 0 0
Back to previous
To report an atypical form of ocular toxoplasmosis with a large retinal granuloma and necrosis adjacent to a small, obscured toxoplasmosis scar.
Detailed ophthalmologic examinations and hematologic tests were performed for the 14-years-old female patient who applied to our clinic for a sudden visual loss in her right eye.
The patient underwent snellen visual acuity, biomicroscopic anterior chamber and dilated fundoscopic examinations. Optical coherence tomography (OCT) was performed Hematologic tests for diagnosis of her retinal lesion and uveitis were done. Oral antitoxoplasmic medications were prescribed for her presumed ocular toxoplasmosis. Her final ophthalmologic examination results were presented following two months of medical therapy.
At presentation, her visual acuity was found to be counting fingers from 1 meters. Biomicroscopy revealed two positive anterior chamber cells and posterior synechiae. Dilated fundus examination revealed a large retinal granuloma surrounded by retinal necrosis in the right macula. OCT showed retinal elevation due to granuloma formation and retinal edema. She underwent hematologic examinations for etiologic diagnosis of her uveitis and retinitis. Anti toxoplasma IgG was found to be positive while IgM was negative. She was given trimethoprim-sulfamethaxasole, azitromycine and low-dose prednisolone treatments regarding presumed ocular toxoplasmosis. During her therapy, when the retinitis started to resolve, we detected a very little pigmentary toxoplasmic scar adjacent to the lesion, which was previously obscured because of retinitis, and that made our diagnosis of toxoplasmosis certain. She went on taking the drugs for 2 months. Her final visual acuity was counting fingers from 5 meters, and the lesion healed, resulting in a pigmentary toxoplasmosis scar shown in ophthalmologic and OCT examinations.
Atypical forms of ocular toxoplasmosis can be seen in pediatric population. Extended use of antitoxoplasmic drugs can be required in such cases with wide involvement and retinal granuloma formation.The old scar may be very small and obscured due to retinal inflammation, making the diagnosis difficult.