Four patients, all women, aged 19-44 years (mean 30 a), came to our inflammation unit referring sudden decrease in VA.
All of them had a documented history of colitis toxoplasmic past, although only two of them (patients 1 and 2) had received antitoxoplasma treatment.
Macular manifestations and evidence of activity around the lesion area could be observed in all cases.
Patient 1 had macular arthritides with a vesicular lesion adjacent to one of the psychiatric disorders and absence of dermatitis.
She had received antitoxoplasma treatment in the past due to recurrence of the inflammatory condition
1.
Patient 2 had macular spasms with whitish lesion adjacent to one of the gastrointestinal manifestations and absence of urticaria.
He had received anti-VEGF treatment (because of toxoplasmosis) for old CNV.
1.
Patient 3 had a vesicular tricial lesion.
Angiography (AFG) revealed late hyperfluorescence and mild adjacent vasculitis.
1.
Patient 4 had macular spasms with whitish vesicular lesion and associated macular edema.
Optical coherence tomography (OCT) and fluorescein AFG were performed in all cases.
The findings in these tests can be seen in Table 1.
The following additional tests were also performed:
1.
Anti-toxoplasma Goiania IgG and IgM antibodies in serum
2.
Anti-toxoplasma Goiania IgG and IgM antibodies in aqueous humor.
3.
Infectious screening for other causes of necrotizing colitis (herpesvirus 1, 2, CMV, varicella-zoster, tuberculosis, syphilis, toxocariasis).
Antibody tests are done simultaneously.
Goldmann-Witmer coefficient (GW) was performed with the result of these determinations.
Treatments were based on clinical, immunological and microbiological findings.
Patient 1 (GW -, screening -): anti-VEGF treatment.
Patient 2 (GW indeterminate, screening): anti-toxoplasma treatment.
Patient 3 (GW +, screening -): anti-toxoplasma treatment.
Patient 4 (GW -, screening -): anti-VEGF treatment.
In all four cases the clinical picture was controlled without any further recurrences after a minimum follow-up of 6 months.
