Paulo Silva Guerra, Margarida Miranda, Joana Couceiro, Walter Rodrigues,

M. Monteiro Grillo

Ophthalmology Department - Hospital de Santa Maria. Director: Prof. Dr. M. Monteiro Grillo

FINANCIAL DISCLOSURES

The authors do not have any financial disclosure

IntroductionIntroduction

• Toxoplasma gondii is recognized as an important cause of ocular disease in humans.6

• Atypical lesions are seen in immunodeficiency due to various causes and also in elderly individuals.4

• In immunodeficient patients, ocular toxoplasmosis constitutes a diagnostic and therapeutic challenge.

To report 3 cases of atypical toxoplasma retinochoroiditis in HIV

positive patients, highlighting the need of systemic evaluation in the

initial diagnosis, which in these cases lead to the diagnosis of HIV

infection .

Purpose:

Material & MethodsMaterial & Methods

Retrospective analysis of 3 patients from Uveitis Department

with panuveitis and sudden loss of visual acuity and vitreous

floaters (HIV infection already known in one case).

All patients were submitted to complete ophthalmic examination

and etiologic and systemic investigation.

CASE 1

• ♀, 35 years, presented with sudden

visual loss and vitreous floaters in the

left eye • LVA at presentation:<0,1• Etiologic and systemic investigation:

IgM- IgG+ (Toxoplasma)

Aqueous PCR: T. gondii +

Ac HIV 1+

CD4+: 417 cel/µL• After treatment: LVA - 0,1

• RE - Normal

• LE - Extensive old pigmented

scar, active retinochoroidal

inflammatory focus, vitritis

CASE 2

• ♂, 29 years, presented with bilateral

progressive loss of vision with 1,5 years

of duration.• Bilateral VA at presentation: <0,1• Etiologic and systemic investigation:

IgM- IgG+ (Toxoplasma)

Aqueous PCR: Negative

Ac HIV 2+, CD4+: 255 cel/µL

Chronic Hepatitis B• After treatment bilateral VA <0,1

• Bilateral, multiple, retinochoroidal

inflammatory lesions

• Several old pigmented scars

• Bilateral vitritis

• Bilateral cicatricial macular changes

CASE 3

• ♂, 26 years (drug addict) • HIV1+ (diagnosed 3 months before)• LVA at presentation: 0,1• Etiologic and systemic investigation:

IgM- IgG+ (Toxoplasma)

Aqueous PCR: T. gondii +

HCV +

CD4+: 42 cel/µL• After treatment: LVA - 0,4

LE:

• Extensive, active retinochoroidal

inflammatory focus with a parapapillary

location

• Tilted disc

• No satellite lesion

Conclusions

In HIV positive patients ocular toxoplasmosis can assume atypical features.

In the presence of toxoplasma retinitis and in atypical presentations the screening for immunodeficiency is mandatory, especially HIV infection.

Aqueous fluid PCR is an important test to confirm the diagnosis, particularly in immunosuppressed patients where the clinical presentation assumes greater variability.

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