Atypical toxoplasmosis presentation mimicking CMV retinitis

Author: Pablo Díaz Aljaro (Spain)

Co-authors: Marta Balboa Miró, Nevena Romanic Bubalo, Ramón Anglada Escalona, Susana Ruiz Bilbao

Purpose

We present the case of a 34-year-old immunocompetent woman who had blurred vision in her left eye for 2 weeks. His medical and epidemiological history highlighted EBV mononucleosis and a trip to the Amazon rainforest during the previous months, in which she underwent an alternative medical therapy based on the consumption of ayahuasca.

Setting/Venue

Hospital Universitari Germans Trias i Pujol

Methods

Fundus examination revealed diffuse hemorrhagic retinitis in the lower nasal quadrant with moderate vitritis. The working hypothesis was infectious retinitis, for which we proceeded to take an aqueous humour sample and blood tests to rule out the most frequent microorganisms according to these risk factors.

Results

Combined treatment of intravenous antiviral drugs (Ganciclovir) with antitoxoplasm therapy (Trimethoprim / Sulfamethoxazole) was started immediately, pending results. During her hospitalization, and under optimal treatment for toxoplasma, the patient presented visual improvement and regression of the retinitis focus, also, blood test resulted positive for toxoplasma primary infection and negative for herpes family in aqueous humour. It was decided to maintain Ganciclovir EV until completing 14 days and change antiparasitic treatment to Sulfadiazine + Pyrimethamine, obtaining major improvement at the end of this period.

Conlusions

Due to the seropositivity and the good response to treatment, we believe that it is an atypical presentation of Toxoplasmosis in the form of retinitis, the characteristics of the retinal lesion made coverage for herpes infection necessary because of the risk posed by acute retinal necrosis.

Financial Disclosure

No financial disclosures