EPI-MEWDS Associated With Ocular Toxoplasmosis: A Case Series
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Yes
Purpose
Epi-MEWDS is a form of multiple evanescent white dot syndrome associated with other posterior segment diseases. This report describes four cases of epi-MEWDS associated with ocular toxoplasmosis (OT) from two centers in Brazil and Spain.
Methods
Retrospective review of clinical, laboratorial and multimodal imaging (MI) data at two uveitis university-based referral centers.
Results
Four patients with epi-MEWDS associated with OT were identified (3 women and 1 man, aged 27-45 years). All presented with unilateral vision loss and photopsia/myodesopsia. Prior diagnosis of OT was present in 3/4 (75%), associated with congenital infection in 2/4 (50%). All patients had one or more typical toxoplasmic scar(s), in the presence of anti-T. gondii IgG. Visual acuity (VA) ranged from 20/20-20/100. Fundoscopy showed the typical small gray-white infiltrates in all patients. One patient had an active satellite lesion, adjacent to a peripheral scar. MI revealed the typical MEWDS pattern, with multifocal hyperautofluorescence in all patients, in addition to overlying disruption of outer retinal layers on SD-OCT. All patients received DS Bactrim, in three of them combined with a tapering prednisone regimen. The remaining patient, with the active lesion, did not receive steroids. All had subsequent resolution of intraocular inflammation in 3-8 weeks, and no recurrences on follow-up.
Conclusion
Epi-MEWS may be overlooked in the setting of OT, being presumably associated with disruption of choriocapillaris-Bruch membrane-RPE complex, as seen in multifocal choroiditis. Clinical presentation and course are similar to classic (primary) MEWDS and antiparasitic coverage may be warranted in case of PO steroid use or active retinochoroiditis.
Conflict of interest
No
1
Last name
DA SILVA BATISTI
Initials of first name(s)
R
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG)
City
Belo Horizonte
Country
Brazil
2
Last name
MOURA
Initials of first name(s)
L
Department
Hospital Clinica Barcelona
City
Barcelona
Country
Spain
3
Last name
DOMENECH
Initials of first name(s)
N
Department
Hospital Clinica Barcelona
City
Barcelona
Country
Spain
4
Last name
LLORENS
Initials of first name(s)
V
Department
Hospital Clinica Barcelona
City
Barcelona
Country
Spain
5
Last name
MACHADO AZEVEDO
Initials of first name(s)
D O
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG)
City
Belo Horizonte
Country
Brazil
6
Last name
DE LA MAZA
Initials of first name(s)
M S
Department
Hospital Clinica Barcelona
City
Barcelona
Country
Spain
7
Last name
ADAN
Initials of first name(s)
A M
Department
Hospital Clinica Barcelona
City
Barcelona
Country
Spain
8
Last name
VASCONCELOS-SANTOS
Initials of first name(s)
D V
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG); Faculdade de Medicina UFMG
City
Belo Horizonte
Country
Brazil
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