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Early-stage ocular toxocariasis: Progression and histopathologic analysis
Alexander M Melendez1, Guillermo A Puebla Robles2, Maria J Marcos Martinez2
1Department of Ophthalmology, University of Puerto Rico, San Juan, PR, USA.
Purpose:
To report progression of early-stage ocular toxocariasis that evolved from retinal granuloma to tractional retinal detachment.
Methods:
Serial ophthalmic examination, multimodal imaging, and histopathological analysis were undertaken.
Case:
A 5-year-old girl without past medical history presented with left eye vision loss of one-week duration. Ophthalmoscopic examination revealed multiple circumscribed retinal granuloma-like lesions affecting the peripheral retina and macula associated with a rhegmatogenous retinal detachment. There was no evidence of vitreoretinal fibrosis/strands at initial examination.
Results:
Initial 2-week treatment with oral albendazole 15mg/kg/daily lacked response, therefore pars plana vitrectomy, excisional biopsy, laser photocoagulation, silicone oil tamponade and sub-tenon triamcinolone injection was performed for management of retinal detachment and macular lesions. Histopathologic analysis showed a retinal granuloma. At the one-month postoperative evaluation, evidence of disease progression including vitreous strands and tractional retinal changes were present. Positive Toxocara IgG titers and peripheral eosinophilia were present. Histopathological analysis demonstrated a retinal granuloma with mixed plasma cells and eosinophils.
Conclusions:
We present a unique case of early-stage ocular toxocariasis in which progression was documented by serial multimodal imaging. The diagnosis was supported by serology and histopathologic analysis.
