We report the case of a 29-year-old black male who came to the Ophthalmology Emergency Department for pain with decreased vision in the right eye (OD).
The examination showed a visual acuity (VA) in the right eye fingers at 3 meters that did not improve with the sternopeic hole and in the left eye (LE) of 1.
Anterior biomicroscopy showed a ciliary injection with complete epithelialization, stromal edema and Descemet membrane folds, the rest of the corneal exploration being normal.
It was decided to start conservative treatment with cycloplegic eye drops and antibiotics.
Two days later, in addition to showing no improvement in her ocular disease, she was associated with hollow headache and vomiting, conservative treatment and referral to Internal Medicine Emergency Department for complete evaluation.
After a systemic examination, a decrease in facial sensitivity in the first branch of the trigeminal nerve was evident with corneal anesthesia.
A computerized axial tomography (CAT) showed triventricular hydrocephalia, cutaneous manifestations in right hemisphere and in left temporal lobe two areas with anti-oxidative treatment internal lobe edema, compatible with internal axial tomography (AU)
Magnetic resonance imaging (MRI) with contrast showed several space-occupying lesions (SLO) in the right and left cerebellar hemispheres, in the temporal lobe and in the operculum suggestive of cerebral toxoplasmosis.
Lumbar puncture (LP) was normal.
In a new anamnesis the patient finds that he has been HIV positive for 2 years due to a sexual risk relationship.
She did not report having been a drug user.
These findings were confirmed by the following serological tests: ELISA and Western blot for HIV, IgM and IgG for toxoplasmosis being positive, reaching the diagnosis of cerebral toxoplasmosis in a patient with HIV.
The CD 4+ T lymphocyte count was 69/μl, with a HIV-RNA copy number of 147.460/ml.
Our diagnosis was neurotrophic ulcer due to trigeminal involvement in the context of cerebral toxoplasmosis.
Since there was no evidence of improvement with treatment previously, autologous serum and therapeutic contact lens were used, without achieving resolution of the clinical picture.
Due to the torpid evolution of the corneal ulcer, a paralytic ptosis is induced by injecting 12 international units of botulinum toxin into the elevator of the upper eyelid due to the non-malignant scarring of the patient.
Finally, it was decided to perform a permanent tarsorrhaphy of two external thirds in the RE, by suturing the anterior and posterior lamellae of both eyelids and treatment with antibiotics and cycloplegic improvement.
