RIFTER or AIFTER? Is It an Atypical Ocular Manifestation of Toxoplasmosis with Positive IgM Serology? A Case Series
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Purpose
To describe three cases of Recurrent Inner Foveal Toxoplasmic Retinitis (RIFTER) in patients with positive IgM serology, exploring its potential link to recently acquired Toxoplasma gondii infection
Methods
Case series
Results
This series involves three patients, who presented RIFTER, an atypical and rare manifestation of ocular toxoplasmosis. All patients had positive IgM serology, confirming recent infection, and none had been previously treated for Toxoplasma gondii. Each patient reported systemic symptoms, about four months before the onset of ocular complaints and no investigations or treatments were conducted at the time.The 17-year-old had decreased visual acuity in the left eye (20/60) a whitish retinal lesion near the disc, and OCT evidence of foveal cavitation involving all retinal layers with peripapillary subretinal fluid. The 31-year-old presented with similar OCT findings but with an isolated abnormal macular reflex. The 49-year-old had macular retinochoroiditis associated with macular fluid, which progressed to characteristic RIFTER features
Conclusion
These cases suggest that RIFTER may occur also in patients with recently acquired toxoplasmosis, particularly those with untreated systemic symptoms. Recognizing this potential association and initiating timely treatment are crucial to preserving vision. Further research is needed to determine the significance of positive IgM serology as a risk factor for this atypical presentation. Based on the findings, the authors propose a nomenclature change for cases presenting as the first manifestation of toxoplasmosis, introducing the term Acute Inner Foveal Toxoplasmic Retinitis (AIFTER) to more accurately describe this condition
Conflict of interest
No
1
Last name
MASU
Initials of first name(s)
W
Department
UNIFESP
City
São Paulo
Country
Brazil
2
Last name
Souza
Initials of first name(s)
G.M
Department
UNIFESP
City
Sao Paulo
Country
Brazil
3
Last name
Souza
Initials of first name(s)
C.E
Department
UNIFESP
City
Sao Paulo
Country
Brazil
4
Last name
Barbosa Neto
Initials of first name(s)
J.P
Department
UNIFESP
City
Sao Paulo
Country
Brazil
5
Last name
Muccioli
Initials of first name(s)
C
City
Sao Paulo
Country
Brazil
6
Last name
Mattos Junior
Initials of first name(s)
R.B
Department
UNIFESP
City
Sao Paulo
Country
Brazil
7
Last name
Finamor
Initials of first name(s)
L.P
Department
UNIFESP
City
Sao Paulo
Country
Brazil
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