Toxoplasma Papillitis

A patient with a history of hypertension, hyperlipidemia, and COPD presented with 10 days of painless, progressive blurry vision of the right eye. On initial examination, the patient was found to have anterior chamber inflammation, vitreous inflammation, and a white retinal lesion in the posterior pole concerning for an acute infectious process. Anterior chamber paracentesis was performed. The patient was treated with both empiric intravitreal antiviral medications as well as oral antiviral and antiparasitic agents due to concern for viral retinitis or Toxoplasma retinochoroiditis. The patient began to improve but was hospitalized due to acute renal failure. The patient was subsequently discharged and was able to resume regular care in the ophthalmic clinic. At this time, aqueous humor PCR results were positive for toxoplasmosis. The patient was improving on oral antimicrobial medications when they developed a sudden decrease in vision and a new visual field defect in the same eye. There was noted to be a granulomatous mass of the optic nerve head, confirming a diagnosis of toxoplasma papillitis. The patient’s treatment continued and her vision improved significantly.

Presentation Date: 05/23/2024

Issue Date: 06/07/2024