Bilateral retinochoroiditis caused by an atypical strain of Toxoplasma gondii
- J Bottós1,
- R H Miller2,
- R N Belfort1,3,
- A C Macedo1,
- UNIFESP Toxoplasmosis Group,
- R Belfort, Jr1,
- M E Grigg2
- 1Vision Institute, Department of Ophthalmology, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
- 2Molecular Parasitology Unit, Laboratory of Parasitic Diseases, NIAID, National Institutes of Health, Bethesda, Maryland, USA
- 3Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
- Correspondence to Dr J Bottós, Vision Institute, Department of Ophthalmology, Federal University of São Paulo, Rua Mirassol 236 ap 22, 04044-010, São Paulo, Brazil; jubottos{at}gmail.com
- Accepted 3 July 2009
- Published Online First 9 August 2009
Abstract
Background: A 53-year-old man presented with an acute bilateral posterior uveitis with extensive necrotising retinochoroiditis but without chorioretinal scarring. A thorough workup did not reveal any underlying disease. The possibilities of atypical ocular toxoplasmosis as well as herpetic retinal necrosis were considered and specific therapy instituted, with little improvement. The patient died within 2 months as result of an undifferentiated squamous cell carcinoma.
Methods: Histopathological examination, immunohistochemistry and multilocus polymerase chain reaction confirmed Toxoplasma gondii infection of the retina
Results: Macroscopic examination of enucleated globe showed extensive retinal necrosis and vitreous detachment. Histological examination of retinal tissue identified numerous round-to-elliptical toxoplasmic cysts within the retina, with retinal necrosis and minimal choroidal inflammation. Immunohistochemical analyses confirmed that the cysts were due to T gondii. DNA extracted from formalin-fixed, paraffin-embedded tissue sections was subjected to multilocus polymerase chain reaction (PCR) analysis at the following typing loci: SAG1, SAG2, SAG3, SAG4, B1, NTS2, GRA6 and GRA7. DNA sequencing of positive PCR products at the NTS2, SAG1 and GRA7 loci confirmed the presence of a non-archetypal strain of T gondii infecting the eye of the patient experiencing a severe, atypical ocular toxoplasmosis
Conclusion: A highly divergent, non-archetypal strain of T gondii was responsible for causing a severe, atypical bilateral retinochoroiditis in a patient from Brazil.
Footnotes
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Funding This work was supported by the Intramural Research Program of the NIH and NIAID. MEG is a scholar of the Canadian Institute for Advanced Research (CIFAR) Program for Integrated Microbial Biodiversity.
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Competing interests None.
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Provenance and Peer review Not commissioned; externally peer reviewed.
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Ethics approval Ethics approval was provided by Federal University of São Paulo.
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Patient consent Obtained.
