The challenges of treating a patient with recurrent congenital toxoplasmic chorioretinitis

Congenital toxoplasmosis is a rare, non-curable parasite infection, that affects approximately 242 children in Europe each year. Poland has one of the highest rates of congenital toxoplasmosis in Europe. Transmission of Toxoplasma gondii to the fetus results in numerous medical conditions, such as developmental delay, intellectual disabilities, seizures, hearing loss, and blindness. Chorioretinitis is a serious manifestation of congenital toxoplasmosis that can recur even after 25 years from the primary infection, which poses a significant therapeutic challenge. A 41-year-old female reported to the Ophthalmology Emergency Room due to blurred vision and pain in the right eye, accompanied by a constant headache. The patient suffered from congenital toxoplasmosis with two relapses in the past. On examination, the best-corrected visual acuity was 1,0 in both eyes, and the intraocular pressure was significantly increased. Slit-lamp examination showed vitritis and an active retinochoroidal lesion in the right eye. In the left eye, there was a retinochoroidal scar. A relapse of toxoplasmosis was suspected. Serology for Toxoplasma gondii was positive. Pyrimethamine with sulfadiazine, clindamycin, topical corticosteroids, and intraocular pressure-lowering drugs were implemented. During the treatment, the patient developed corticonuclear cataract in both eyes and reported psychotic symptoms. Clinical condition improved after the treatment with corticosteroids at a lower dose. Treatment of ocular manifestations of congenital toxoplasmosis is challenging. The clinical benefit of treatment should be weighed against side effects for each patient. Running title: Congenital toxoplasmosis treatment

Foveal Regeneration after Treatment of Acute Foveal Toxoplasmic Chorioretinitis

Purpose: To report a patient with impaired vision due to foveal involvement of toxoplasmic chorioretinitis, who was successfully treated with intravitreal and oral therapy and led to successful visual and anatomic recovery.Case presentation: A thirty two-year-old man presented with three-day history of gradually decreasing visual acuity, redness, pain and photophobia of the right eye. Anterior chamber cellular reaction, vitritis and a white retinochoroiditis patch with adjacent retinal vasculitis in the fovea was suggestive of the toxoplasmic chorioretinitis. He was treated with intravitreal Clindamycin and Dexamethason injection followed by six-week regimen of Azithromycine, Trimethoprim-Sulfamethoxazole, and Prednisolone. In serial optical coherence tomography imaging, retinitis patch changed to cavitary foveal destruction. Fovea was regenerated gradually, and visual acuity was concurrently improved from counting finger 3m to 20/25. Conclusion: In foveal toxoplasmic chorioretinitis lesions, timely treatment is associated with retinal regeneration and visual improvement.

Ocular side effects of antirheumatic medications: a qualitative review

TopicThis paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions.Clinical relevanceRheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions.MethodsPubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs.ResultsA total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review.ConclusionThe goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.

Failure of systemic oral doxycycline in preventing ocular toxoplasmic retinochoroiditis in French military personnel

This paper describes two cases of toxoplasmic chorioretinitis presenting in two French soldiers who had been receiving oral doxycycline for malaria prophylaxis. This is despite the proven effectiveness of oral doxycycline in treating Toxoplasma gondii, the most common cause of this infection. The lack of effectiveness of oral doxycycline in these two cases most likely reflected that the ocular concentration of 100 mg daily doxycycline is too low to treat or prevent Toxoplasmic retinochoroiditis (TC). Clinicians should therefore be aware that soldiers taking prophylactic oral doxycycline are still at risk of developing ocular TC with potentially sight-threatening consequences if not treated adequately.