gms | German Medical Science

Ocular toxoplasmosis is an important opportunistic retinal infection in patient with different degrees of immunosuppression.

We report a case of 61-years-old man presented with blurred vision in his right eye. The patient has periarteriitis nodosa, treated with steroids and immunosuppressive agents for a period of 3 years. In his medical history, he described sudden visual loss in his left eye 2 years ago. At presentation the left eye is blind without light perception and visual acuity of the right eye was 20/40. Fundus examination revealed an active retinochoroiditis adjacent to an old scar, with mild vitritis in the right eye. Examination of the left eye demonstrated atrophic optic nerve disc without other lesions in the fundus. The diagnosis of ocular toxoplasmosis is based on typical clinical features supported by positive serology test. Optic disc atrophy of the left eye could be explaned as a result of his systemic disease - periarteriitis nodosa. After antitoxoplasmic therapy the ocular inflammation was healed. Prophylaxis with trimethoprime-sulfamethoxazole against reccurences for the only seeing eye is undertaken.

Toxoplasmic infection was reactivated during the treatement with immunosuppressive agents for the systemic connective tissue disease. Detailed eye evaluation is recommended in patients on immunosuppressive therapy, for prevention of opportunistic eye infections.