Case of the Week – Jump into the fog⁠

Here’s a 29yo female South American traveller referred in for left eye discomfort for 3 days and an initially raised intraocular pressure (IOP) of 48mmHg that has been treated by the referrer. ⁠

On examination of the left eye, she had cells in the anterior chamber and anterior vitreous. Fundoscopy of the left eye showed a new pale area of chorioretinitis adjacent to a major vessel and previous toxoplasmosis scar in the superotemporal quadrant. Right eye examination was unremarkable⁠
Multimodal imaging demonstrates the hazy vitreous in Image 2 as well as the “headlight in fog” appearance of the lesion. ⁠

The angiogram (images 3 &4) demonstrates the choroidal non-perfusion of the lesion (image 3) as well as the choroidal blockage due to pigmentation of the existing scar. It also shows disc leakage and lowgrade vasculitis (image 4). ⁠

SD-OCT B images (5&6) show the thickened, raised and hyperreflective choroid, disorganised retina with overlying vitritis. The scans beautifully show the chorioretinitis and vitritis interface.⁠

This is patient has Toxoplasmosis Chorioretinitis, confirmed on PCR through an AC tap.⁠

On further questioning, the patient has a long history of pet cats. ⁠

She responded well to combined treatment of Bactrim and steroids (systemic and topical).⁠

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