Bilateral Ocular Toxoplasmosis that Caused Optic Atrophy Secondary to Papillitis

ABSTRACT

Purpose@#We report a case of ocular toxoplasmosis that caused bilateral optic atrophy secondary to papillitis.Case summary: A 52-year-old male with no history of systemic disease was referred to our clinic because of visual field blurring in the left eye for four weeks. The visual acuity was 20/20 in the right eye and 20/25 in the left eye. A relative afferent pupillary defect and diffuse field loss were noted in the left eye. On fundus examination, left-side blurring of the disc margin and a peripapillary hemorrhage were evident, but there was no sign of inflammation in the right fundus. Systemic evaluation, including brain magnetic resonance imaging, was performed for differential diagnosis of left papillitis. Immunoserologically, he was positive for toxoplasma immunoglobulin (Ig)M and IgG. We diagnosed ocular toxoplasmosis presenting as left papillitis, and systemic antibiotics and a steroid were started. After six weeks, the left disc swelling was reduced but disc pallor was evident and his visual acuity decreased to 20/40. A new inflammatory lesion of the right optic disc developed two weeks after the medication was stopped, so the treatment was applied for a further two months. However, bilateral optic atrophy developed. @*Conclusions@#Bilateral papillitis caused by ocular toxoplasmosis may trigger optic atrophy secondary to optic nerve involvement.When a patient presents with disc swelling suggestive of papillitis caused by ocular toxoplasmosis, rapid and aggressive antitoxoplasma treatment is essential to avoid a poor visual outcome.