Abstrait

Diffuse toxoplasmic retinochoroiditis as an initial manifestation of AIDS

Vikram V Koundanya, Benazir Ansari, Jyotirmay Biswas

Ocular toxoplasmosis commonly presents with typical clinical features of focal retinitis patch over the posterior pole, often at the border of a preexisting retinochoroidal scar, with an overlying vitreous haze. Although the disease is known to present with atypical clinical features like papillitis, neuroretinitis, diffuse necrotizing retinochoroiditis etc. in patients with Acquired Immunodeficiency Syndrome (AIDS), it is very rare for such features to present as an initial manifestation of AIDS. Such atypical clinical features also pose a great diagnostic challenge, especially when the immune status of the patient is not known. We hereby report a case where diffuse toxoplasmic retinochoroiditis presented as an initial manifestation of AIDS. The patient was initially diagnosed to have viral retinitis but polymerase chain reaction from anterior chamber tap confirmed toxoplasmosis. Serum ELISA was positive for HIV 1 with a viral load of 22,067 copies/ml. The patient was successfully treated with systemic and intravitreal anti-toxoplasma medication along with Highly Active Anti-Retroviral Therapy (HAART). The importance of early diagnosis of HIV with early initiation of HAART cannot be understated. We recommend that Toxoplasma infection should be kept in the differential diagnosis of diffuse retinochoroiditis. We also recommend HIV screening of adults with newly diagnosed ocular toxoplasmosisOcular toxoplasmosis commonly presents with typical clinical features of focal retinitis patch over the posterior pole, often at the border of a preexisting retinochoroidal scar, with an overlying vitreous haze. Although the disease is known to present with atypical clinical features like papillitis, neuroretinitis, diffuse necrotizing retinochoroiditis etc. in patients with Acquired Immunodeficiency Syndrome (AIDS), it is very rare for such features to present as an initial manifestation of AIDS. Such atypical clinical features also pose a great diagnostic challenge, especially when the immune status of the patient is not known. We hereby report a case where diffuse toxoplasmic retinochoroiditis presented as an initial manifestation of AIDS. The patient was initially diagnosed to have viral retinitis but polymerase chain reaction from anterior chamber tap confirmed toxoplasmosis. Serum ELISA was positive for HIV 1 with a viral load of 22,067 copies/ml. The patient was successfully treated with systemic and intravitreal anti-toxoplasma medication along with Highly Active Anti-Retroviral Therapy (HAART). The importance of early diagnosis of HIV with early initiation of HAART cannot be understated. We recommend that Toxoplasma infection should be kept in the differential diagnosis of diffuse retinochoroiditis. We also recommend HIV screening of adults with newly diagnosed ocular toxoplasmosis