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Ruptured Retinal Arterial Macroaneurysm Secondary to Toxoplasmic Kyrieleis Arteriolitis: A Case Report
Natalie Huang1,2, W Andrew Lee3, Sean Rivera2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
Purpose:
The aim of this report was to describe multimodal ocular imaging findings in a patient who presented with a ruptured retinal arterial macroaneurysm (RAM) associated with toxoplasmic Kyrieleis arteriolitis.
Methods:
We report the case of a 64-year-old man with a history of systemic hypertension and dense amblyopia of the left eye who presented with decreased vision and new floaters in the left eye. Color fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography were used as diagnostic imaging tools.
Results:
No signs of hypertensive retinopathy were noted in the right eye. Multiple chorioretinal scars characteristic of previous toxoplasmosis were revealed in the left eye, with one covering most of the macula. Periarterial plaques or Kyrieleis arteriolitis were observed in retinal arteries surrounding the toxoplasmic retinal scars. Multiple RAMs were observed in these vessels, one of which was acutely ruptured. A perivenular plaque associated with a chronic branch retinal vein occlusion (BRVO) was noted along the same arcade at the arteriovenous crossing.
Conclusion:
RAM formation and BRVO can present as possible long-term complications of toxoplasmic Kyrieleis arteriolitis. This is the first reported case demonstrating an association between toxoplasmic Kyrieleis arteriolitis and RAM formation.
Insights
Toxoplasmic Kyrieleis arteriolitis may lead to retinal arterial macroaneurysms (RAM) and branch retinal vein occlusion (BRVO). This case highlights the first documented association between toxoplasmic Kyrieleis arteriolitis and RAM formation.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Vascular Imaging
Background:
- Toxoplasmic Kyrieleis arteriolitis is a rare inflammatory condition affecting retinal vessels.
- Retinal arterial macroaneurysms (RAM) are dilations of retinal arteries, which can rupture and cause vision loss.
- Ocular toxoplasmosis can lead to various retinal complications.
Observation:
- A 64-year-old male presented with decreased vision and floaters.
- Multimodal imaging revealed chorioretinal scars, periarterial plaques (Kyrieleis arteriolitis), multiple RAMs (one ruptured), and a branch retinal vein occlusion (BRVO).
- No hypertensive retinopathy was observed.
Findings:
- The case demonstrates a ruptured RAM associated with toxoplasmic Kyrieleis arteriolitis.
- Evidence of chronic toxoplasmosis and associated vascular changes were noted.
- A coexisting BRVO was observed along the same vascular arcade.
Implications:
- This is the first reported case linking toxoplasmic Kyrieleis arteriolitis to RAM formation.
- RAM and BRVO may be potential long-term complications of this inflammatory arteritis.
- Understanding these associations is crucial for managing patients with ocular toxoplasmosis and vascular complications.
