A 16-year-old Caucasian female presented to our department with sudden vision loss in her right eye. Systemic evaluation was negative for any systemic illnesses. She was not on any systemic medications nor had a family history of eye illnesses. Visual acuity was count-fingers at 50 cm in the right eye and 20/20 with -1.75 diopter spherical correction in the left eye. There was +2 aqueous cells in the anterior chamber and +2 anterior vitreous cells in the right eye. Corneal endothelial mutton-fat keratic precipitates were also noted in the right eye. Slit-lamp examination of the left eye was unremarkable. Intraocular pressure was 14 mmHg in both eyes.
Dilated funduscopic examination revealed a diffuse, elevated white-yellow lesion in the right retina with 1.5 times the diameter of the optic disc in size that was located half a disc diameter temporal to the optic nerve head. Focal condensation of inflammatory cells in the vitreous was observed overlying an area of active chorioretinitis (Figure 1). Chest x-ray, complete blood count, and serum biochemistry, including angiotensin-converting enzyme, were within normal limits. Purified protein derivative of tuberculin was negative. Titers for Toxoplasma gondii -specific IgM (3.1 IU/mL) and IgG (4.3 IU/mL) were elevated. The patient was consulted to the pulmonology department due to suspicion of tuberculosis and sarcoidosis, both of which were ruled out. Based on the serological findings and clinical presentation, the ocular toxoplasmosis was diagnosed.
The patient was put on oral clindamycin 300 mg q.i.d, azithromycin 500 mg q.d, and trimethoprim-sulfamethoxazole 800/160 mg q.d, and for the right eye only topical anti-inflammatory treatment with prednisolone acetate ophthalmic every two hours and tropicamide ophthalmic t.i.d. After 1 week of treatment, the patient's visual acuity in the right eye increased to 20/160. Dilated funduscopic examination of the right eye showed a decrease in vitreous haze (Figure 2). After 1 month of treatment visual acuity in the right eye was 20/60 and dilated funduscopic examination of the right eye showed a decrease in the size of the macular infiltrate (Figure 3).
After 3 months of treatment, the patient presented with complaints of flashing lights and floaters in her right eye. Dilated funduscopic examination showed a horseshoe retinal tear at the 9 o'clock position. The retinal tear was treated with Argon laser photocoagulation immediately (Figure 4). At the 6-month follow-up visual acuity in the right eye was 20/40 and slit-lamp examination findings were within normal limits. Additionally, dilated funduscopic examination of the right eye showed fibrotic tissue at the toxoplasmic retinochoroiditis spot, and active vitreous inflammation was not noted. Furthermore, the horseshoe retinal tear was well circumscribed with laser scars (Figure 5).
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Patient's written consent was obtained regarding the fundus images that were used in this manuscript.