Optic nerve toxoplasmosis and orbital inflammation as initial presentation of AIDS.
OBJECTIVE
To report a case of toxoplasmosis with optic nerve and orbital involvement as the initial presentation of HIV infection.


METHODS
Case report.


RESULTS
A 46-year-old zookeeper, who had had right central retinal vein occlusion (CRVO) 2 weeks previously, presented with painless lid and conjunctival swelling and profound visual loss in his right eye (RE). Examination revealed no light perception (NLP) RE with axial proptosis and ocular motility restriction; fundal examination revealed a clinical picture of an ischaemic CRVO. MRI of the brain and orbit showed ring-enhancing targetoid lesions in the brain and inflammatory changes in the right optic nerve, extraocular muscles and orbital fat. He was subsequently found to be HIV positive and had positive toxoplasma IgG serology.


CONCLUSIONS
Immunocompromised individuals have an increased likelihood for more severe and atypical presentations; this highlights the need for increased index of suspicion for HIV infection as ocular or orbital disease may be the first manifestation of life-threatening systemic toxoplasmosis.
Ocular Inflammation and Immunology, Singapore National Eye Centre, 11, Third Hospital Avenue, Singapore 168751, Singapore.
Mun-Wai
MW
Lee
Kee-Siew
KS
Fong
Li-Yang
LY
Hsu
Wee-Kiak
WK
Lim
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001762:Blepharitis / Q000175:diagnosis / Q000188:drug therapy; D018791:CD4 Lymphocyte Count; D003231:Conjunctivitis / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D006679:HIV Seropositivity; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy; D016727:Orbital Pseudotumor / Q000175:diagnosis* / Q000188:drug therapy; D011739:Pyrimethamine / Q000627:therapeutic use; D012170:Retinal Vein Occlusion / Q000175:diagnosis; D013411:Sulfadiazine / Q000627:therapeutic use; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis* / Q000188:drug therapy
D044966:Anti-Retroviral Agents; D013411:Sulfadiazine; D002955:Leucovorin; D008775:Methylprednisolone; D011739:Pyrimethamine