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Atypical, severe toxoplasmic retinochoroiditis in elderly patients
M W Johnson1, G M Greven, G J Jaffe
1W.K. Kellogg Eye Center, Department of Ophthalmology, University of Michigan School of Medicine, Ann Arbor 48105, USA.
Ophthalmology
|January 1, 1997
Summary
Toxoplasmic retinochoroiditis can present atypically in elderly patients, often mimicking other severe retinal conditions. Early diagnosis and treatment are crucial, though relapses may occur, leading to vision loss.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Toxoplasmic retinochoroiditis diagnosis relies on ocular findings and serology.
- Recognizing atypical presentations is key for prompt antiparasitic therapy.
Observation:
- Seven immunocompetent elderly patients (69-82 years) presented with severe, atypical toxoplasmic retinochoroiditis.
- Three cases were initially misdiagnosed as acute retinal necrosis syndrome.
- Cases confirmed by treatment response, PCR, or histopathology.
Findings:
- Necrotizing retinochoroiditis was multifocal/diffuse, nonhemorrhagic, and without arteritis.
- Prolonged antiparasitic treatment was often necessary, with four relapses.
- Significant visual loss occurred in most affected eyes.
Implications:
- Toxoplasmosis should be considered in elderly patients with severe necrotizing retinitis.
- Age-related immune decline may increase susceptibility to severe ocular toxoplasmosis.
- Atypical presentations necessitate a high index of suspicion for accurate diagnosis and management.
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