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Last additions - 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 Consumption396 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption409 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption407 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption377 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption376 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption406 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption396 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption437 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption410 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption476 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption408 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption482 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption427 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption430 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption386 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption389 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption377 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption384 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption449 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption371 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption405 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption413 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption392 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption391 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption393 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption387 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption373 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption410 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption394 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption404 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption418 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption433 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption393 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption394 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption394 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption389 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption406 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption472 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption400 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption393 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption413 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption410 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption417 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption406 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption376 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption468 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption472 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/sulfaApr 19, 2020	Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption407 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/sulfaApr 19, 2020
Acquired Toxoplasmosis Retinitis Para Foveal - Following Venison Consumption451 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/sulfaApr 19, 2020
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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