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CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 20-22

Retinitis pigmentosa and congenital ocular toxoplasmosis: a rare coexistent case presentation


Department of Ophthalmology, King George's Medical College, Lucknow, Uttar Pradesh, India

Date of Web Publication20-Apr-2017

Correspondence Address:
Sourav Kumar Bose
42/1, Dr. Meghnad Saha Road, P. O. Motijheel, Kolkata - 700 074, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/erj.erj_19_16

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  Abstract 

Retinitis pigmentosa (RP) is the term used for a group of disorders that are characterized by inherited, progressive dysfunction, cell loss, and eventual atrophy of retinal tissue. Ocular toxoplasmosis can cause blindness secondary to the retinitis present in the posterior pole of the eye or vitreoretinal complications in the acute or recurrent form of the disease. A 30-year-old male patient presented with the complaint of diminution of vision of both eyes since birth, especially at night. The best corrected visual acuity was hand movement perception in the right eye and finger counting close to face in the left eye with projection of rays full in all quadrants (both eyes). Fundus photograph and optical coherence tomography macula confirmed fundal changes characteristic of RP and large, punched out, healed macular scar, preliminarily appearing as a congenital toxoplasmosis scar. A thorough literature search revealed only one such previously reported case report.

Keywords: Hereditary ocular diseases, infectious retinal diseases, retinitis pigmentosa, toxoplasmosis


How to cite this article:
Bose SK, Katiyar V, Gupta S. Retinitis pigmentosa and congenital ocular toxoplasmosis: a rare coexistent case presentation. Egypt Retina J 2017;4:20-2

How to cite this URL:
Bose SK, Katiyar V, Gupta S. Retinitis pigmentosa and congenital ocular toxoplasmosis: a rare coexistent case presentation. Egypt Retina J [serial online] 2017 [cited 2017 Aug 18];4:20-2. Available from: http://www.egyptretinaj.com/text.asp?2017/4/1/20/204840


  Introduction Top


Retinitis pigmentosa (RP) is the term used for a group of disorders that are characterized by inherited, progressive dysfunction, cell loss, and eventual atrophy of retinal tissue.[2] Initial involvement of photoreceptors leads to subsequent damage to inner retinal cells. Ocular toxoplasmosis can cause blindness secondary to the retinitis present in the posterior pole of the eye or vitreoretinal complications in the acute or recurrent form of the disease.[3] Here, we report a rare case of coexistent RP and congenital ocular toxoplasmosis in and adult patient. Extensive research based on keywords RP, toxoplasmosis, hereditary ocular diseases, and infectious retinal diseases showed one case presentation [1] citing coexistent RP and congenital toxoplasmosis from India. It also described the sample patient to be having the same complaint and same clinical findings.


  Case Report Top


A 30-year-old male patient presented with the complaint of diminution of vision of both eyes since early childhood. There was no other significant history.

On ophthalmological examination, the best corrected visual acuity was hand movement perception in the right eye and finger counting close to face in the left eye with projection of rays full in all quadrants (both eyes). Intraocular pressure was within normal limits. The anterior segment was normal in all aspects. Fundus examination with indirect ophthalmoscope revealed pale disc, arteriolar attenuation, and bony spicules all over the posterior pole (BE). This was accompanied by a large, punched out, healed macular scar, preliminarily appearing as a congenital toxoplasmosis scar.

Systemic examination did not reveal any abnormality.

The patient was advised fundus photograph and an optical coherence tomography macula. The reports are shown in [Figure 1],[Figure 2],[Figure 3],[Figure 4]. Electroretinography was done, which showed diminished amplitude of both a and b waves in both the eyes. Serological test for detection of Toxoplasmagondii was not done, since it is not confirmatory.
Figure 1: Fundus photo of the right eye.

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Figure 2: Fundus photo of the left eye.

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Figure 3: Optical coherence tomography of the right eye.

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Figure 4: Optical coherence tomography of the left eye.

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  Discussion Top


The classically described fundus appearance of RP includes attenuated retinal vessels, mottling and granularity of the retinal pigment epithelium (RPE), bone spicule intraretinal pigmentation, and optic nerve head pallor. The most common complaint of the patient is that of night blindness, followed by peripheral visual field loss. The patient had the typical features of RP. The retina is the primary site of T.gondii infection in the eye, and the hallmark is a necrotizing chorioretinitis satellite lesion adjacent to old hyperpigmented scars accompanied by vitreous inflammation and anterior uveitis. Retinal vasculitis also was present. In most cases, it is a self-limited disease. With passage of enough time, the lesion becomes more well defined, hyperpigmented, and acquires a crumpled paper appearance. The central part shows white scleral exposure. Again, these features were typically found in our patient.

The most common clinical signs of active ocular toxoplasmosis are blurring or loss of vision and floaters. However, our patient could not appreciate floaters, the probable cause being involvement of the macula as well as coexisting disc and RPE changes due to RP.

The course of progression of RP had also been modified by the presence of toxoplasmic chorioretinitis scar involving the macula. The usual visual acuity of patients suffering from RP is 1.00 and 1.20 on the LogMAR scale. Our patient had a worse visual acuity, as already mentioned.

Hence, we conclude that coexisting RP and congenital toxoplasmosis leads to rapid deterioration of vision of both eyes and contributes to accelerated ocular morbidity. It remains to be seen whether treatment directed at treating either condition has a role to control the other as well and whether any visual outcome will be gained out of it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chhabra MS, Prakash G, Vashisht N, Garg SP. Retinitis pigmentosa and congenital toxoplasmosis: A rare coexistence. Indian J Ophthalmol 2007;55:303-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK1417/. [Last accessed on 2016 Dec 25].  Back to cited text no. 2
    
3.
Kieffer F, Wallon M. Congenital toxoplasmosis. Handb Clin Neurol 2013;112:1099-101.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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