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Toxoplasmic chorioretinitis and hepatic granulomas.
T J Ortego1, B Robey, D Morrison
1Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock.
The American Journal of Gastroenterology
|October 1, 1990
Summary
A 71-year-old man with fever and weight loss was diagnosed with toxoplasmosis. His liver function improved spontaneously, indicating a self-limiting course for this opportunistic infection.
Area of Science:
- Infectious Diseases
- Hepatology
- Ophthalmology
Background:
- Toxoplasma gondii is an opportunistic pathogen that can cause systemic illness in immunocompetent individuals.
- Hepatic and ocular manifestations can occur in toxoplasmosis.
- Differential diagnosis of fever, malaise, and elevated liver enzymes is broad.
Observation:
- A 71-year-old male presented with a 2-month history of fever, malaise, and weight loss.
- Physical examination revealed chorioretinitis, and laboratory studies showed elevated liver enzymes.
- Serological testing confirmed high immunoglobulin G titers for Toxoplasma gondii, with negative results for other infectious agents.
Findings:
- Liver biopsy revealed hepatic granulomas, but cultures for mycobacteria and fungi were negative.
- The patient experienced spontaneous improvement in clinical and laboratory parameters over 4 months.
- These findings are consistent with a diagnosis of acquired toxoplasmosis.
Implications:
- This case highlights the importance of considering toxoplasmosis in the differential diagnosis of unexplained fever, weight loss, and liver enzyme abnormalities, even in immunocompetent individuals.
- Ocular involvement (chorioretinitis) can be a presenting sign of systemic toxoplasmosis.
- The self-limiting nature of the illness in this patient suggests that not all cases of acquired toxoplasmosis require specific antiparasitic treatment.