Case report

An 11 year old boy noticed poor vision in right eye accidentally. Vision in right eye was 1/60. Right eye fundus showed yellowish white raised lesion with surrounding oedema and irregular pigmentation in parafoveal region( Fig1.). Left eye was normal.

IgG toxoplasma was high. He was put on a course of Clindamycin and oral steroids. The lesion regressed to chronicity and vision improved (Fig2.).

Figure 1

Figure 1

Figure 2

Figure 2

Discussion

Ocular toxoplasmosis congenital variety is transmitted transplacentally.

Chorioretinal scar often bilateral is seen in 80% patients with congenital toxoplasmosis (₁). The retinal lesions may be self limited and healed already at birth or may develop months or years after birth(₂). The diagnosis of toxoplasmosis is primarily a clinical one. Serological tests are used in selective cases – Sabin-Feldman dye test, ELISA, Indirect Hemeagglutination Test etc. Newer diagnostic modalities include Western Blot, PCR and Immunofluorescence test(₃).

Toxoplasmosis in immunocompetent individuals is self limited. A two line decrease in visual acuity, lesions located within temporal arcade or affecting optic nerve, moderate to severe vitreous inflammation heralds treatment(₂).

Triple therapy with pyrimethamine, sulfadiazine and oral steroids and quadruple therapy with addition of clindamycin is traditionally used. Several authors believe that clindamycin alone or in combination is an effective antimicrobial drug that can cause rapid resolution of lesions and reduce recurrences. (₄)