Focal yellow lesion at macula: the mimickers of Toxoplasma retinitis
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Yes
Purpose
To demonstrate various atypical presentations of retinitis at macula mimicking Toxoplasma retinochoroiditis (TRC).
Methods
Retrospective case series wherein the lesions mimicked and were diagnosed as TRC at the presenting visit.
Results
14 patients were recruited of whom eight received antiparasitic therapy which was later changed to etiology specific treatment. The commonest mimicker we noted in this series was focal fungal retinitis (seven eyes, microbiologically proven in six eyes) followed by Tubercular focal chorioretinitis (four eyes), Toxocara retinitis (two eyes) and Syphilitic (one eye). Most common feature that led to the diagnostic bias initially was focal retinitis adjacent to pigmented scar (n=8) followed by vitritis (n=5 ) and vasculitis (n=1). Revision of diagnosis was based on clues from OCT combined with with deep vitreous biopsy (seven cases). Fundus evaluation and fundus photo based clues included – 1. whitish coloured retinitis 2. Subretinal nodular/abscess-like lesion 3.Choroidal granuloma with subretinal fibrous exudation. OCT features leading to revision of diagnosis from Toxoplasma retinitis were 1. Subretinal location of lesion with or without rain cloud sign 2. Choroidal granuloma with subretinal fibrin mimicking as Toxoplasma retinitis lesion. 3. Compact intraretinal infiltrate 4. Absence of choroidal thickening
Conclusion
Focal yellow lesion with an adjacent pigmented scar; mimicking Toxoplasma retinitis was seen due to fungal retinitis, Tubercular chorioretinitis, Toxocara and/or syphilis as the mimickers. They could be differentiated based on a combination of clinical features, multimodal imaging, deep vitreous biopsy and/or serological diagnoses.
Conflict of interest
No
1
Last name
KELGAONKAR
Initials of first name(s)
Anup
Department
Uveitis, vitreous and retina
City
Bhubaneswar
Country
India
2
Last name
Jadhav
Initials of first name(s)
V
Department
Uveitis, vitreous and retina
City
Visakhapatnam
Country
India
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