Original articleDiagnosis of toxoplasmic retinochoroiditis with atypical clinical features
Section snippets
Design
Retrospective case series.
Methods
Sixty-seven consecutive patients who presented initially with clinical features suggestive of atypical T. gondii retinochoroiditis underwent a diagnostic anterior chamber paracentesis. Clinically, all 67 patients showed retinitis without a retinal or chorioretinal scar and the presence of varying numbers of cells in the vitreous humor. All 67 cases also had one or more of the following features: (1) multiple foci of acute retinitis or retinochoroidal lesions either in the posterior pole or in
Results
The PCR test was positive for T. gondii in nine patients, and seven of these nine were negative for the Goldman-Witmer coefficient (≤ 3.0). These nine cases also had retinal lesions measuring 12.1 ± 6.6 DA (Figure 1). Eight of these nine patients had obvious causes of immunosuppression (Table 1). The ninth patient was an 86-year-old woman with no apparent cause of immunosuppression. All nine patients showed positive serological tests (IgG) for T. gondii infection; two also showed anti-T.
Discussion
The typical clinical presentation of ocular toxoplasmosis includes focal retinitis at the border of a preexisting pigmented retinochoroidal scar. In recent years, however, it appears that such typical manifestations may not be observed in all cases. Patients often present with one large focus or multiple smaller foci of posterior retinitis, peripheral necrotizing retinitis, signs of retinal vasculitis, or a focus of retinitis without adjacent pigmented retinal scars.1 Such atypical
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