Optical coherence tomography angiography findings in macular toxoplasma retinochoroiditis: A case report

Abstract

Purpose: To report the optical coherence tomography angiography (OCT-A) findings in a patient with macular toxoplasma retinochoroiditis (TRC). Observations: A 14-year old female presented with a 2-week history of decreased vision of her right eye. Upon presentation, on the right eye, visual acuity was 20/200 and the fundus revealed 2+ vitritis and an active parafoveal area of retinitis superotemporally. Toxoplasma serology revealed positive IgG and negative IgM. Initial treatment consisted of intravitreal clindamycin (1.0mg in 0.1 mL) with dexamethasone (1.0 mg in 0.1 mL) along with oral trimethoprim/sulfamethoxazole, azithromycin and prednisone; of which the trimethoprim/sulfamethoxazole was discontinued 4 days into therapy due to a pruritic rash. Six-weeks after the presentation, the oral prednisone had been tapered off, and all therapy discontinued. The patient had complete resolution of TRC and recovered 20/20 vision. OCT-A analysis of the right macula, performed after completion of treatment, revealed preservation of foveal perfusion along a parafoveal area of ischemia, superotemporally, at the superficial and deep retinal vascular complexes, including the choriocapillaris. Conclusion and Importance: In macular TRC, OCT-A may help to assess therapeutic outcomes from a vascular perspective. To our knowledge, our case represents the first description in the medical literature of OCT-A findings in macular TRC.

Keywords

• Optical coherence tomography angiography
• Macula
• Toxoplasma retinochoroiditis
• Intravitreal clindamycin