Correspondence Address:
Dr. Pranav Ish
Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room No. 638, Superspeciality Block, New Delhi - 110 029
India

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Dear Editor,

A 14-year-old female presented with sudden-onset diminution of vision of the left eye for 1 day both for distance and near vision. It was associated with redness and mild pain. She was myopic and was using spectacles for 3 years. The patient was healthy and well oriented to time, place, and person, and vitals were stable. On ocular examination, the best-corrected visual acuity (BCVA) of the right eye was 6/6 and the left eye was 6/60. The anterior segment of the right eye was normal. In the left eye, there was mild conjunctival congestion, the cornea was clear, the anterior chamber (AC) depth was normal, AC flare 1+, the pupil was round and normally reacting to light, and the lens was transparent. On the fundus examination, the right eye was normal. In the left eye, Grade 1 vitritis was present. An irregular, yellowish, around one, and half-disc diameter in size lesion with fluffy margin with subretinal fluid was present in the macula involving fovea [Figure 1]a. Optical coherence tomography (OCT) macula left eye showed loss of the foveal contour with intraretinal fluid and breach in the retinal pigment epithelium with hyperreflectivity below it suggestive of chorioretinitis [Figure 1]a. A provisional diagnosis of left eye toxoplasma chorioretinitis was made, and the patient was started on tablet trimethoprim (160 mg) and sulfamethoxazole (800 mg) combination twice a day with topical and systemic steroids (1 mg/kg).{Figure 1}

Complete blood count, blood sugar level, Antinuclear antibodies were normal. Human Immunodeficiency virus serology was negative. Computed tomography of the chest and ultrasound of the abdomen were normal. Blood investigations subsequently revealed positive immunoglobulin G antibodies for toxoplasma.

After 2 weeks, the patient's BCVA left eye improved to 6/24 and then to 6/18. After 6 weeks, treatment was stopped and steroids were gradually tapered and stopped. BCVA left eye was 6/12. On fundus examination, the lesion was dried up with pigmentation [Figure 1]b. On OCT macula of the left eye [Figure 1]b, the foveal contour was returning to normal with resolution of subretinal fluid. Hyperreflectivity present in the subretinal pigment epithelium also decreased.

Ocular toxoplasmosis has long been regarded as a disease that was mainly caused by congenital infection, while symptomatic ocular infection acquired after birth was considered rare. This school of thought was challenged by a study from Brazil, which demonstrated that postnatal infection and ocular manifestations of toxoplasmosis were more common than congenital infection.[1] Postnatal infection is, therefore, a common cause of ocular toxoplasmosis and must be kept as a differential for underlying etiology of chorioretinitis.[2]

Blurring of vision is often the main complaint of ocular toxoplasmosis patients. Unfortunately, diagnosis confirmation requires the detection of antibodies or parasite DNA. Ocular toxoplasmosis, if not treated early, can cause loss of vision due to vision-threatening complications such as retinal detachment, choroidal neovascularization, and glaucoma.[3] Accurate diagnosis thus depends heavily on the characteristic clinical features of this disease.[4]

To conclude, a high index of suspicion must be kept for toxoplasmosis as a cause of chorioretinitis in young adults so that early clinical diagnosis can be made and early appropriate therapy can prevent disastrous complications.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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