https://orcid.org/0000-0003-3838-1075
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ABSTRACT
Purpose
To present an atypical case of severe bilateral ocular toxoplasmosis with systemic involvement that initially mimicked an autoimmune etiology, posing challenges to its diagnosis and treatment.
Case Report
A 39-year-old immunocompetent male was admitted to the hospital due to a presumed pulmonary thromboembolism concomitant with an abrupt onset of vision loss. Initial differential diagnoses included antiphospholipid syndrome and systemic lupus erythematosus, prompting the administration of corticosteroid pulses and rituximab. Despite observing a partial systemic response, there was no improvement in visual acuity. Subsequent aqueous humor polymerase chain reaction confirmed Toxoplasma gondii infection, leading to the introduction of oral antibiotic therapy. The patient’s condition showed a partially favorable response; however, the treatment could not reverse the permanent retinal damage.
Conclusion and importance
This case underscores the importance of ruling out an infectious etiology in all cases of uveitis. Additionally, it alerts clinicians to the possibility that elevated positive autoantibodies may result from a severe inflammatory reaction caused by pathogens rather than an autoimmune or autoinflammatory disease, particularly in instances of poor treatment response or atypical clinical presentation.
Abbreviations
| SLE | = | Systemic lupus erythematosus |
| APS | = | Antiphospholipid syndrome |
| IS | = | Immunosuppressive |
| AIDs | = | Autoinflammatory diseases |
| VA | = | visual acuity |
| OD | = | Right eye |
| OS | = | Left eye |
| OU | = | Both eyes |
| CF | = | Counting fingers |
| AC | = | Anterior chamber |
| DD: | = | Disk diameter |
| FA | = | Fluorescein Angiography |
| CRAO | = | Central retinal artery occlusion |
| BRAO | = | Branch retinal artery occlusion |
| OCT-A | = | Optical coherence tomography angiography |
| TMP-SMX | = | Trimethoprim-sulfamethoxazole |
| INF-a | = | Interferon-α |
| IL-12 | = | Interleukin-12 |
| IFN-Y | = | Interferon-Y |
| ROP18 | = | Rhoptry protein 18 |
| CMV | = | Cytomegalovirus |
| EBV | = | Epstein-Barr Virus |
| PCR | = | Polymerase chain reaction |
Acknowledgments
We thank the patient for granting permission to publish this information.
Consent for publication
Written informed consent was obtained prior to the publication of this case report. A copy of the informed consent can be requested for review to the Editor-in-Chief of this journal.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
Patient information is not publicly available due to the protection of medical data privacy but is available on reasonable request from the corresponding author.