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INTRODUCTION: Toxoplasma chorioretinitis is a leading cause of infectious posterior uveitis worldwide. METHODS: We report an atypical presentation of Toxoplasma chorioretinitis presenting after uneventful cataract surgery in an 81-year-old male, with known hypernephroma and rheumatoid arthritis, treated with prednisolone and methotrexate. RESULTS: He was treated for acute retinal necrosis and cytomegalovirus retinitis before Toxoplasma chorioretinitis was confirmed by vitreous biopsy 11 months after presentation. He developed a secondary rhegmatogenous retinal detachment, treated successfully with pars plana vitrectomy, silicone oil and endolaser. Visual acuity at discharge was 6/12 following silicone oil removal. DISCUSSION: Necrotising chorioretinitis in immunosuppressed or elderly patients may present with an atypical phenotype. Clinical diagnosis in this context remains challenging. We discuss the clinical reasoning behind investigation and management of this patient group in whom viral and Toxoplasma retinitis may be clinically indistinguishable. The significance of vitreous PCR results in clinical decision making in the context of infectious posterior uveitis is discussed.

Original publication

DOI

10.3109/09273948.2014.891756

Type

Journal article

Journal

Ocul Immunol Inflamm

Publication Date

06/2015

Volume

23

Pages

261 - 265

Keywords

Immunosupression, Toxoplasma chorioretinitis, investigation, phacoemulsification, posterior uveitis, postoperative iritis, toxoplasmosis, Aged, 80 and over, Chorioretinitis, Choroid, Diagnosis, Differential, Follow-Up Studies, Humans, Male, Phacoemulsification, Reoperation, Retina, Visual Acuity, Vitrectomy