Toxoplasma Papillitis and Neuroretinitis

Introduction: Toxoplasma is a leading cause of posterior uveitis in immunocompetent patients manifesting as a focal posterior retinochoroiditis. It also causes systemic disease with potentially lethal complications. This obligate intracellular parasite has worldwide distribution with an estimated 1 billion people affected. 1 The typical Toxoplasma lesion consists of fluffy gray or white-yellow retinal infiltrates adjacent to an old pigmented scar with overlying exudation of the vitreous.2,3 Several unusual presentations in ocular toxoplasmosis have been reported, including: papillitis, neuroretinitis, retrobulbar neuritis, outer retinal toxoplasmosis,4 central serous retinopathy, retinal detachment, macular edema,5 scleritis,6 and multifocal diffuse necrotizing retinitis in the elderly.7 Complications of ocular toxoplasmosis include secondary glaucoma, CME,8 vascular occlusion,9,10,12 retinal neovascularization,10 choroidal neovascularization,11 subretinal neovascularization.12 We report a case of presumed ocular toxoplasmosis presenting initially as papillitis with minimal vitritis and severely diminished vision that evolved into neuroretinitis while under treatment. We also review several case reports of primary optic nerve involvement in toxoplasmosis.