Korean J Ophthalmol.  2008 Sep;22(3):197-200. 10.3341/kjo.2008.22.3.197.

Bilateral Toxoplasma Retinochoroiditis Simulating Cytomegalovirus Retinitis in an Allogeneic Bone Marrow Transplant Patient

• Chung H
• Kim JG
• Choi SH
• Lee SY
• Yoon YH

• KMID: 1070759
• DOI: http://doi.org/10.3341/kjo.2008.22.3.197

Abstract

A 36-year old female with acute myelogenous leukemia presented with a sudden decrease in vision one month following bone marrow transplantation (BMT). She had been taking multiple immunosuppressants to treat her recently-developed graft-versus-host-disease (GVHD). Visual acuity was 20/60 in her right eye and 20/25 in her left. Ophthalmic examination revealed mild inflammatory reaction in both the anterior chamber and the vitreous of both eyes, as well as densely opaque yellow-white infiltrates with well-demarcated borders in the posterior retina of both eyes. She was originally diagnosed as CMV retinitis, but treatment with ganciclovir failed to improve her ocular condition. Subsequent work-up, including serology and brain MRI, led to a diagnosis of combined ocular and cerebral toxoplasmosis. After 6 weeks of antiparasitic therapy, her retinal lesions became inactive and her cerebral lesions improved. Immunosuppressed patients with necrotizing retinochoroiditis should be suspected of having toxoplasmosis. Accurate differentiation between this condition and CMV, and early intervention with the appropriate treatment may be critical to preserve the best vision.

Keyword

Bone marrow transplantation; Toxoplasmic retinochoroiditis

MeSH Terms

Adult
Anti-Bacterial Agents/therapeutic use
*Bone Marrow Transplantation
Chorioretinitis/*diagnosis/drug therapy/parasitology
Clindamycin/therapeutic use
Cytomegalovirus Retinitis/*diagnosis
Drug Therapy, Combination
Female
Functional Laterality
Humans
Leukemia, Myeloid, Acute/*surgery
Magnetic Resonance Imaging
Tomography, Optical Coherence
Toxoplasmosis, Cerebral/*diagnosis/drug therapy
Toxoplasmosis, Ocular/*diagnosis/drug therapy
Transplantation, Homologous
Trimethoprim-Sulfamethoxazole Combination/therapeutic use

Figure

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  Fig. 1 Fundus photographs and optical coherence tomography (OCT) at presentation in the patient's right (a, b) and left (c, d) eyes. Her visual acuity was 20/60 in the right eye and 20/25 in the left eye.

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  Fig. 2 Fundus photographs of both eyes 2 weeks after the initiation of intravenous ganciclovir (a, b). Her visual acuity had decreased to 20/400 in the right eye and 20/60 in the left eye.

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  Fig. 3 Magnetic resonance imaging of the brain showing multifocal, ill-defined nodular enhancing lesions in both cerebral hemispheres and basal ganglia.

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  Fig. 4 Fundus photographs and OCT of right eye (a, b) and left (c, d) after 6 weeks of antiparasitic therapy. Her visual acuity remained poor due to the formation of epiretinal membrane and atrophy of her neurosensory retinas.

Reference

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