Toxoplasmosis chorioretinitis mimicking acute retinal necrosis associated with local corticosteroid

• Type of Material: Article
• Authors: Jason nN. Crosson, Emory University; Sanjana Kuthyar, Emory University; Jessica Shantha, Emory University; Matthew R. Debiec, Emory University; Philip W. Laird, Emory University; CS Hwang, Emory University; Hans Grossniklaus, Emory University; Steven Yeh, Emory University
• Language: English
• Date: 2020-06-03
• Publisher: BMC Publications
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s40942-020-00225-0
• Title of Journal or Parent Work: International Journal of Retina and Vitreous
• Volume: 6
• Issue: 1
• Start Page: 21
• End Page: 21
• Grant/Funding Information: Supported by an unrestricted grant from Research to Prevent Blindness to the Emory Eye Center and National Eye Institute, National Institutes of Health Core Grant to Emory University (P30EY006360).; Research reported in this publication was supported by the National Eye Institute of the National Institutes of Health (Awards: RO1 EY029594 and K23EY030158).
• Keywords: Toxoplasmosis; Acute retinal necrosis; Corticosteroids
• Research Categories: Health Sciences, Pathology; Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery

Abstract

Background The cases discussed highlight the atypical presentation and diagnostic dilemmas of toxoplasmosis with fulminant retinal necrosis and the potentially devastating visual outcomes of toxoplasma chorioretinitis following local corticosteroid exposure. Case presentation We report a series of three patients who presented with toxoplasmosis mimicking severe acute retinal necrosis. Patients were between 59 and 77 years old and had been exposed to local corticosteroids preceding our evaluation. All patients demonstrated diffuse retinal whitening with severe vision loss on presentation. Polymerase chain reaction testing (PCR) was diagnostic in two patients, and histopathologic examination of a vitrectomy specimen was diagnostic in one patient. All cases of retinitis resolved with anti-parasitic medication; however, visual acuity failed to improve in all patients due to disease severity and presentation. Conclusions Local corticosteroid injection may trigger or exacerbate toxoplasmosis chorioretinitis, leading to fulminant retinal necrosis and severe vision loss. Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, particularly following local corticosteroid injection regardless of their baseline systemic immune status. Diagnostic vitrectomy may be helpful in patients in whom PCR testing is negative and ocular toxoplasmosis is suspected.