TOXOPLASMOSIS RETINOCHOROIDITIS MASQUERADING AS ENDOGENOUS ENDOPHTHALMITIS IN A CASE OF CONGENITAL LONG QT SYNDROME

Purpose: To describe the diagnostic and treatment challenges of a case of presumed acquired macula-involving toxoplasmosis retinochoroiditis.

Methods: Case report of a female with congenital long QT syndrome (CLQTS) presenting with retinochoroiditis after undergoing a cardiac procedure. Laboratory analysis, ocular fluid biopsy, and multimodal imaging were obtained.

Results: Ophthalmic exam was significant for decreased vision and a macula-involving chorioretinal lesion concerning for endogenous endophthalmitis (EE). Multimodal imaging showed a focal, full thickness necrotizing process associated with vitritis, retinal edema, and choroidal thickening. Analysis of peripheral blood revealed elevated serum toxoplasma IgG titers. Blood cultures and a transesophageal echocardiogram were negative for endocarditis. Aqueous and vitreous specimens were negative for an infectious PCR panel including toxoplasmosis and negative bacterial and fungal cultures. A diagnosis of presumed acquired toxoplasmosis retinochoroiditis was made and treated with a combination of oral and intravitreal anti-parasitic medications resulting in healing of the retinochoroiditis.

Conclusion: To the author's knowledge, this is the first reported case of acquired toxoplasmosis retinochoroiditis in an immunocompetent patient with CLQTS masquerading as EE. The association of CLQTS and recent cardiac procedure with risk for EE complicated the diagnosis, clinical course, and treatment options. Our case emphasizes the importance of a thorough patient history, comprehensive clinical exam, and supportive multimodal imaging which were utilized to characterize the infectious process and guide empirical treatment. Additionally, laboratory analysis, co-management with other specialists, and evaluating the response to anti-toxoplasma therapy were all instrumental in the eventual diagnosis and treatment of ocular toxoplasmosis in this atypical case.