title: Toxoplasma gondii: an atypical presentation of toxoplasma as optic disc swelling and hemispherical retinal vein occlusion treated with intravitreal clindamycin.
abstract: BACKGROUND
  To present a case of toxoplasmosis with an atypical presentation and treated successfully with intravitreal clindamycin.
  
  
  METHODS
  A young Brazilian woman presented with panuveitis and disc swelling with associated hemispheric vascular occlusion in one eye. The presumed diagnosis was of a papillitis with vasculitis due to an unknown inflammatory condition.
  
  
  RESULTS
  Following treatment with intravenous corticosteroids, macular star appeared 1 week after treatment. On the 2nd week, a focus of retinitis appeared, and the patient was started on antitoxoplasma treatment. This was poorly tolerated, and the patient was injected with intravitreal clindamycin. Inflammation eventually settled and an organized lesion typical of toxoplasma chorioretinitis was observed.
  
  
  CONCLUSIONS
  We describe an unusual presentation and the detrimental effects of toxoplasmosis in an otherwise immunocompetent subject. As the patient was not tolerating systemic antitoxoplasma treatment, intravitreal injection was administered and proved to be effective and well tolerated.
authors.affiliation: Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, City Road, London EC1V 2PD, UK. drrogerwong@aol.com
authors.forename: Roger
authors.initials: R
authors.lastname: Wong
authors.forename: Roberto
authors.initials: R
authors.lastname: dell'Omo
authors.forename: Michele
authors.initials: M
authors.lastname: Marino
authors.forename: Badrul
authors.initials: B
authors.lastname: Hussein
authors.forename: Narciss
authors.initials: N
authors.lastname: Okhravi
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Pavesio
mesh_terms: D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002981:Clindamycin / Q000008:administration & dosage*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage; D010211:Papilledema / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D016133:Polymerase Chain Reaction; D012170:Retinal Vein Occlusion / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014122:Toxoplasma / Q000235:genetics*; D014123:Toxoplasmosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D014606:Uveitis, Anterior / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D002981:Clindamycin; D008775:Methylprednisolone