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Int Ophthalmol (2009) 29:195198 DOI 10.1007/s10792-008-9192-8
CASE REPORT
Toxoplasma gondii: an atypical presentation of toxoplasma as optic disc swelling and hemispherical retinal vein occlusion treated with intravitreal clindamycin
Roger Wong Roberto dellOmo Michele Marino Badrul Hussein Narciss Okhravi Carlos E. Pavesio
Received: 7 May 2007 / Accepted: 9 January 2008 / Published online: 23 February 2008 Springer Science+Business Media B.V. 2008
Abstract Background To present a case of toxoplasmosis with an atypical presentation and treated successfully with intravitreal clindamycin. Method A young Brazilian woman presented with panuveitis and disc swelling with associated hemispheric vascular occlusion in one eye. The presumed diagnosis was of a papillitis with vasculitis due to an unknown inammatory condition. Results Following treatment with intravenous corticosteroids, macular star appeared 1 week after treatment. On the 2nd week, a focus of retinitis appeared, and the patient was started on antitoxoplasma treatment. This was poorly tolerated, and the patient was injected with intravitreal clindamycin. Inammation eventually settled and an organized lesion typical of toxoplasma chorioretinitis was observed. Conclusion We describe an unusual presentation and the detrimental effects of toxoplasmosis in an otherwise immunocompetent subject. As the patient was not tolerating systemic antitoxoplasma treatment, intravitreal injection was administered and proved to be effective and well tolerated.
Keywords Clindamycin Retinitis
Toxoplasma gondii
Introduction
We present an atypical presentation of toxoplasma as optic disc swelling and hemispherical retinal vein occlusion lacking localized chorioretinitis treated with intravitreal clindamycin.
Methods/materials
A 25-year-old Brazilian woman attended our emergency department with a 5-day history of pain and loss of vision in the left eye. She had no previous medical or ophthalmic history and was on no regular medication. Systemic enquiry revealed mild left-sided headache, but no other signs or symptoms. There was no history of contact with cats or kittens. She did have a bacillus Calmette-Guerin scar on her left arm.
Results
On examination, best corrected visual acuity was 6/5 and hand movements on the right and left eye, respectively. There was a left relative afferent pupillary defect and superior hemield loss. Intraocular pressure was 16 and 10 mmHg on the right and left eye, respectively. Examination of the right eye was normal. The anterior...