Atypical Ocular Toxoplasmosis With Remote Vasculitis and Kyrieleis Plaques

Abstract

Retinal vasculitis is common in ocular toxoplasmosis (OT) and typically occurs in the same quadrant as retinochoroiditis. This is a case of atypical ocular toxoplasmosis with remote vasculitis distant from the retinochoroiditis lesion. Examination of the left fundus showed the classic posterior segment finding of "headlight in the fog" in the absence of a chorioretinal scar. Retinal vasculitis was noted in all four quadrants at the periphery far from the retinitis area. A presumptive diagnosis of acute panuveitis secondary to ocular toxoplasmosis was made despite the enzyme-linked immunosorbent assay (ELISA) for Toxoplasmosis antibody being pending. The patient was treated empirically with oral sulfamethoxazole-trimethoprim for eight weeks and received both oral and topical corticosteroids. His symptoms and ocular signs have significantly improved. This case report highlights an atypical remote localization of vasculitis with the classic appearance of retinochoroiditis and vitritis, which is highly due to toxoplasmosis. Early initiation of antibiotic therapy is recommended despite pending serology to ensure a good final visual and ocular outcome.

Keywords: atypical; atypical ocular toxoplasmosis; kyrieleis plaques; ocular toxoplasmosis; remote vasculitis.

Figure 1. Keratic precipitates on the central corneal endothelium

Figure 2. Classic “headlight in the fog” chorioretinitis (green arrow) was seen superior to the hyperaemic swollen optic disc during the presentation

Figure 3. Fundus examination at presentation showed multiple punctate choroiditis (red arrows) with retinal vasculitis (green arrows) at the far periphery of the inferior retinal

Figure 4. (A): Pre-treatment. (B): Following treatment, the previously seen vitritis in (A) was completely resolved while the focal chorioretinitis lesion became more well-defined

Figure 5. (A): Pre-treatment. (B): Multiple punctate inferior choroiditis were resolved and resolving peripheral vasculitis along with Kyrieleis plaques (green arrows) were observed during the treatment (B)