J Korean Ophthalmol Soc.  2013 Sep;54(9):1463-1468.

Presumed Ocular Toxoplasmosis Presenting as Isolated Unilateral Papillitis

• Lee HJ
• Kim SG
• Lee SH
• Jeong JH

Abstract

PURPOSE
To report an atypical case of ocular toxoplasmosis presenting as isolated unilateral papillitis.
CASE SUMMARY
A 53-year-old female presented with visual difficulty in her right eye that had begun 1 week previously. Best corrected visual acuity was 0.8 in the right eye and 1.0 in the left eye. On fundoscopic examination, optic disc swelling and focal edema with hard exudates in the nasal parapapillary retina were found in her right eye. Fluorescein angiography revealed marked leakage of dye from the swollen optic disc. There was no evidence of vasculitis and chorioretinitis. Pupillary light reflex and color vision were normal. Visual field (VF) showed generalized reduction in the right eye, and was normal in the left eye. Optical coherence tomography (OCT) revealed right optic disc swelling. Serology was positive for toxoplasma IgM and IgG. The patient was treated with oral steroids and antitoxoplasma antibiotics. Two months later, visual acuity was 1.0 in the right eye. There was no disc swelling on fundoscopy or OCT and VF was normal.
CONCLUSIONS
Ocular toxoplasmosis can present atypically as isolated papillitis without chorioretinitis and mimic idiopathic optic neuritis. A thorough serologic examination for toxoplasmosis along with proper treatment should be performed.

Keyword

Neuroretinitis; Ocular toxoplasmosis; Optic neuritis; Papillitis; Toxoplasma IgM

MeSH Terms

Anti-Bacterial Agents
Chorioretinitis
Color Vision
Edema
Exudates and Transudates
Eye
Female
Fluorescein Angiography
Humans
Hydrazines
Immunoglobulin G
Immunoglobulin M
Light
Middle Aged
Optic Neuritis
Papilledema
Reflex
Retina
Retinitis
Steroids
Tomography, Optical Coherence
Toxoplasma
Toxoplasmosis
Toxoplasmosis, Ocular
Vasculitis
Visual Acuity
Visual Fields
Anti-Bacterial Agents
Hydrazines
Immunoglobulin G
Immunoglobulin M
Steroids

Figure

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  Figure 1. (A) Fundus photography showing optic disc swelling with focal peripapillary nasal retinal edema and hard exudates in the right eye. (B) Normal optic disc and retina in the left eye. (C) Fluorescein angiography showing pro-found active leaking of dye from the right optic disc.

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  Figure 2. Visual field (VF) showing central scotoma in the right eye.

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  Figure 3. Optical coherence tomography (OCT) showing optic disc swelling and hard exudates in the right eye.

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  Figure 4. Fundus photography showing normal optic disc after 5 weeks of treatment but still existence of hard exudates.

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  Figure 5. VF showing no visual field defect in both eyes after 7 weeks.

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  Figure 6. OCT showing normalized peripapillary retinal nerve fiber layer thickness and no hard exudates in the nasal retina after 7 weeks of treatment.

Reference

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