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An unusual manifestation of ocular toxoplasmosis

Poster Details

First Author: I.Leal PORTUGAL

Co Author(s):    A. Barata   R. Couceiro   M. Canastro   C. Perpetua   C. Ferreira   F. Pinto     

Abstract Details

Purpose:

Toxoplasmosis represents the most important cause of posterior uveitis worldwide and may lead to visual threatening complication. Classic ocular disease includes retinochoroiditis and inflammatory cellular infiltration of overlying vitreous. Ocular toxoplasmosis manifesting as granulomatous uveitis is considered atypical. Our aim is to report an unusual clinical manifestation of ocular toxoplasmosis in an immunocompromised patient.

Setting:

Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal

Methods:

We report the case of a 28-year-old black man that was systemically immunosuppressed with corticosteroids and cyclosporine due to a graft versus-host disease. He had previously received a bone-marrow transplant due to an accelerated chronic myeloid leukemia.

Results:

This patient (with a blameless ophthalmological history) presented in our Emergency Department with complaints of loss of visual acuity (VA) in his left eye (LE), accompanied by pain and photophobia for approximately a month. He had a normal ophthalmological exam in his right eye. However, LE VA was perception of hand movements and LE biomicroscopy presented marked conjunctival hyperemia, microcystic corneal edema, exuberant endothelial mutton-fat keratic precipitates, hematic tyndall with inferior hyphema and iris neovessels. Moreover, there was a dense cataract that prevented fundus examination. Mode B echography suggested vitritis with no retinal detachment.

Conclusions:

Due to severe intraocular inflammation in an immunocompromised patient, diagnostic anterior chamber paracentesis was performed. The resultant aqueous humor tap had a yellowish color and polymerase chain reaction (PCR) analysis showed the presence of Toxoplasma gondii. A 5-month course of anti-toxoplasma therapy (sulfadiazine, pyrimethamine and folinic acid) was given and inflammation gradually subsided. As his systemic condition has been controlled, the patient is awaiting cataract surgery. In cases with sight-threatening complications and with less typical presentation, invasive investigations need to be employed, including PCR of ocular fluids. It is mandatory to treat aggressively immunosuppressed individuals with active ocular toxoplasmosis.

Financial Disclosure:

NONE

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