Published in:
01-11-2006 | Case Report
Optic nerve toxoplasmosis and orbital inflammation as initial presentation of AIDS
Authors:
Mun-Wai Lee, Kee-Siew Fong, Li-Yang Hsu, Wee-Kiak Lim
Published in:
Graefe's Archive for Clinical and Experimental Ophthalmology
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Issue 11/2006
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Abstract
Purpose
To report a case of toxoplasmosis with optic nerve and orbital involvement as the initial presentation of HIV infection.
Results
A 46-year-old zookeeper, who had had right central retinal vein occlusion (CRVO) 2 weeks previously, presented with painless lid and conjunctival swelling and profound visual loss in his right eye (RE). Examination revealed no light perception (NLP) RE with axial proptosis and ocular motility restriction; fundal examination revealed a clinical picture of an ischaemic CRVO. MRI of the brain and orbit showed ring-enhancing targetoid lesions in the brain and inflammatory changes in the right optic nerve, extraocular muscles and orbital fat. He was subsequently found to be HIV positive and had positive toxoplasma IgG serology.
Conclusions
Immunocompromised individuals have an increased likelihood for more severe and atypical presentations; this highlights the need for increased index of suspicion for HIV infection as ocular or orbital disease may be the first manifestation of life-threatening systemic toxoplasmosis.