Acute papillitis in young female with toxoplasmosis

Skin in the game

A 23-year-old man with a history of migraine and focal seizures, developed painless visual loss in the left eye associated with optic disk edema. There was no recent history of cat exposure except for a cat that lives outside. Initial laboratory studies were negative. magnetic resonance imaging brain and orbits without and with fat suppression and intravenous contrast was normal. The patient admitted to routinely skinning, processing and consuming deer while not wearing gloves, and he also frequently had cuts on his hands while doing so. The serum Toxoplasma gondii IgG antibody returned at >400 (0-7.1 IU/mL) with the IgM at 10.4 (0-7.9 AU/mL).

Management of Systemic Steroid in HIV Patient with Toxoplasma Papillitis

BACKGROUND

Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii. Ocular manifestations are seen in both congenital and acquired toxoplasmosis. These can include focal inflammation within or around the optic nerve head (papillitis). Purpose of this study is evaluating the efficacy of systemic steroid in HIV patient with toxoplasma papillitis.

CASE PRESENTATION

We present a case report of a male, 46 years old with a decrease of visual acuity on the right eye for three weeks before admission to the hospital. An ophthalmology examination showed visual acuity of the right eye 1/60, mild dilatation of the pupil and posterior synechiae, vitreous was hazy, and fundus examination showed optic nerve head not well demarcated and hyperaemic with the good retina and macula reflex. Laboratory examination showed reactive anti-Toxoplasma immunoglobulin G. Patient had been treated with antiretroviral and anti-Toxoplasma drugs, then he was given steroid 250 mg intravenously four times per day for three days and tapering off orally. Visual acuity on the right eye improve from 1/60 became 6/60 after use of steroid on the third day.

DISCUSSION

Steroid can improve visual acuity for toxoplasma papillitis in this patient. But the long term and close follow up in steroid therapy is needed.

Toxoplasmosis Neuroretinitis: A Case Report

Introduction

Neuroretinitis (NR) is considered to be an inflammatory condition which is characterized by optic disc edema and, as a result, formation of a macular star figure. NR is an atypical presentation of toxoplasmosis infection, and such cases are quite rare.

Case Presentation

A 13-year-old girl presented with painless subacute visual loss in her right eye for a week at Khatam-Al-Anbia eye hospital in Mashhad, Iran. Following comprehensive evaluation, a diagnosis of toxoplasmic NR was made. The NR favorably responded to classic anti-toxoplasmosis treatment. A juxtapapillary retinochoroidal scar appeared after disc swelling resolution.

Conclusions

Although toxoplasmosis NR is rare, it should be considered in the differential diagnoses of NR.

Infectious optic neuropathies: a clinical update

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.