Spectral domain optical coherence tomography imaging of punctate outer retinal toxoplasmosis

Punctate outer retinal toxoplasmosis is a recognized phenotype of this common ocular parasite. We present a case presenting with poor visual acuity, but with prompt treatment regaining excellent vision by the final time point. Imaging demonstrates progression of an active lesion adjacent to an inactive retinal scar with color photography, fluorescein angiography, and Spectral Domain Optical Coherence Tomography (SD-OCT). SD-OCT imaging of the chorioretinal scar demonstrated alternating hypertrophy and atrophy of the retinal pigment epithelium along with a discrete break in Bruch's membrane. At baseline, the active lesion demonstrated a large collection of inflammatory subretinal fluid adjacent to an area of active retinitis. Over time, the subretinal material was found to resolve, there was restoration of the foveal anatomy, and the area of retinitis progressed into a chorioretinal scar.