Toxoplasma gondii bradyzoites and tachyzoites isolation from vitreous of atypical necrotizing retinitis

Abstract

Background: Detection of Toxoplasma gondii cysts in vitreous of immunocompetent patient with necrotizing retinitis is extremely rare. We herein report the isolation of Toxoplasma bradyzoites and tachyzoites from the vitreous of healthy person.

Results: A 19-year-old immunocompetent female presented with sudden loss of vision in left eye since 1 week. The BCVA was 6/6 and HM in right and left eye. The left eye finding was suggestive of diffuse necrotizing retinitis with retinal detachment. The IgM and IgG for TORCH infection were negative and HIV, HCV and HBsAg tests were also non reactive. The patient underwent diagnostic and therapeutic vitrectomy with silicon oil installation. The vitreous toxoplasma IgG titre was found to be significantly raised to 1:16. Bradyzoites of toxoplasma were identified in H&E staining and tachyzoites of Toxoplasma were identified in Giemsa staining of vitreous sample. She received oral clindamycin and oral corticosteroid but the vision could not be restored in left eye.

Conclusion: Hence, atypical toxoplasmosis with necrotizing retinitis is a fulminant condition with the diagnostic and therapeutic challenge.

Fig. 1

Mutton-fat KPs (brown outline) and Koeppes’ nodules (blue outline)

Fig. 2

Poor fundal glow in the left eye

Fig. 3

Band-like hyperechogenic structure extending from the vitreous base towards the posterior hyaloid surface and optic nerve head

Fig. 4

Bradyzoites of Toxoplasma were seen in H&E staining

Fig. 5

Tachyzoites of Toxoplasma were seen in Giemsa staining

Fig. 6

Poor fundal visualization even after vitrectomy