Open Access Brief report

A typical bilateral Toxoplasma retinochoroiditis in a bone marrow transplant patient with negative serum titers

Albert Hazan1, Rakesh M Patel2, David Levinson2, Umar Mian2 and David C Gritz23*

Author Affiliations

1 Albert Einstein College of Medicine, Bronx, NY, 10467, USA

2 Department of Ophthalmology and Visual Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA

3 Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, 111 East 210th St., Bronx, NY 10467, USA

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Journal of Ophthalmic Inflammation and Infection 2013, 3:23  doi:10.1186/1869-5760-3-23

Published: 28 January 2013

Abstract

Background

Toxoplasma retinochoroiditis can have an atypical presentation and be difficult to diagnose in immunocompromised patients. Accurate diagnosis and appropriate treatment is important since the disease can be aggressive in these patients. This paper is a case report with literature review, emphasizing on the diagnosis and treatment of Toxoplasma retinochoroiditis.

Findings

A 27-year-old male with chronic myelogenous leukemia with history of bone marrow transplantation presented with floaters in his right eye. Fundus exam showed bilateral, multifocal retinochoroiditis with subsequent development of a mild vitritis. Serum cytomegalovirus and toxoplasmosis antibody titers and syphilis screen were negative. Aqueous polymerase chain reaction (PCR) analysis revealed the presence of Toxoplasma gondii DNA OU. Clindamycin (1.0 mg/0.1 mL) was injected bilateral intravitreal OU twice at 4 days apart with subsequent resolution of retinochoroiditis.

Conclusions

When evaluating retinochoroiditis in an immunocompromised patient, one must keep a high index of suspicion for atypical presentations of well-known disease entities. Aqueous and vitreous samples for PCR can be useful in obtaining an accurate diagnosis and therefore provide appropriate management for the patient. Intravitreal clindamycin is an option for treatment in these patients.

Keywords:
Intravitreal clindamycin; Toxoplasma retinochoroiditis; Toxoplasma gondii