Toxoplasmosis Retinitis - BRAO - Primary - After eating venison
|
|
56 year old man The patient has a new cotton wool spot with hemorrhage in the left eye. There is a blur superiorly in the left eye. He has a history of high blood pressure. BP 162/98
VA OD: sc20/63 PH20/32 NccJ3
VA OS: Dcc20/25 NccJ16
IOP: TP: OD:23 OS:18
NEGATIVE:
Posterior retinitis
Patient started on Bactrim BID, Valtrex 1000 mg TID
Anterior Chamber Tap negative for VZV,HSV,CMV, and Toxoplasmosis
ACE, Lysozyme, CXR, RPR, FTA-ABS negative
Lyme, CBC, CMP, UA negative
ANA had turned positive
Brain MRI normal
Management:
Intravitreal Gancyclovir Given (possible CMV)
Vision started to improve within one week:
2/11/20 – presentation – 20/25
2/18/20 – 4/200
2/20/20 – 4/200
2/21/20 – 4/200 – IV Gancyclovir Given
2/25/20 – 20/63 lesion smaller – less edema
2/28/20 – 20/32
A TEST CAME BACK POSITIVE
Toxoplasmosis
IgM > 160 (negative < 8.0)
IgG > 400 (negative < 6.0)
30% of the world population is infected with toxoplasmosis
1/3 congenital
2/3 acquired
North America – 10% - 30% prevalence
Latin America – 60% prevalence
Definitive host – cats
Intermediate host – mammals
Transmission:
Cat feces
Undercooked meat with tissue cysts
Infection during pregnancy fetal transmission
Recurrence rate 5 years: 79%
Recurrence less common in treated patients
Management 4-6 weeks (randomized study showed equivalent):
Pyrimethamine, sulfadiazine, steroids
Clindamycin, sulfadiazine, steroids
Bactrim, steroids
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption3 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption3 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption3 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption2 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption3 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption5 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption5 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption7 views56 year old man who became very sick after eating venison at the end of December 2019. Presented 6 weeks later with a scotoma. Initial photos show presentation with 20/63 vision. Vision dropped to 5/200. All tests (including PCR of anterior chamber tap) were negative except serum toxoplasmosis IgG and IgM. Vision improved to 20/32 but the scotoma remained on oral trimetheprim/sulfa
(0 votes)
|
|
|
|
|
|
|
56 year old man The patient has a new cotton wool spot with hemorrhage in the left eye. There is a blur superiorly in the left eye. He has a history of high blood pressure. BP 162/98
VA OD: sc20/63 PH20/32 NccJ3
VA OS: Dcc20/25 NccJ16
IOP: TP: OD:23 OS:18
NEGATIVE:
Posterior retinitis
Patient started on Bactrim BID, Valtrex 1000 mg TID
Anterior Chamber Tap negative for VZV,HSV,CMV, and Toxoplasmosis
ACE, Lysozyme, CXR, RPR, FTA-ABS negative
Lyme, CBC, CMP, UA negative
ANA had turned positive
Brain MRI normal
Management:
Intravitreal Gancyclovir Given (possible CMV)
Vision started to improve within one week:
2/11/20 – presentation – 20/25
2/18/20 – 4/200
2/20/20 – 4/200
2/21/20 – 4/200 – IV Gancyclovir Given
2/25/20 – 20/63 lesion smaller – less edema
2/28/20 – 20/32
A TEST CAME BACK POSITIVE
Toxoplasmosis
IgM > 160 (negative < 8.0)
IgG > 400 (negative < 6.0)
30% of the world population is infected with toxoplasmosis
1/3 congenital
2/3 acquired
North America – 10% - 30% prevalence
Latin America – 60% prevalence
Definitive host – cats
Intermediate host – mammals
Transmission:
Cat feces
Undercooked meat with tissue cysts
Infection during pregnancy fetal transmission
Recurrence rate 5 years: 79%
Recurrence less common in treated patients
Management 4-6 weeks (randomized study showed equivalent):
Pyrimethamine, sulfadiazine, steroids
Clindamycin, sulfadiazine, steroids
Bactrim, steroids
