title: The absence of vitreous inflammation: one more challenge in diagnosing toxoplasma papillitis.
abstract: Toxoplasma is a leading cause of posterior uveitis in immunocompetent patients manifesting as a focal posterior retinochoroiditis. The clinical diagnosis of ocular toxoplasmosis is usually straightforward. There is typically a fluffy white retinal lesion which may lie adjacent to a pigmented chorioretinal scar and a prominent vitreous, or additionally, anterior chamber cellular reaction. Several unusual presentations in ocular toxoplasmosis have been reported, including: papillitis, neuroretinitis, retrobulbar neuritis, retinal detachment and macular oedema. This is a case of presumed primary toxoplasma papillitis in a 14-year-old child with complete absence of vitritis at presentation that made the diagnosis challenging. This evolved into neuroretinitis that resolved upon introducing antitoxoplasma antibiotics.
authors.affiliation: University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK. drmok@hotmail.co.uk
authors.forename: Michael Adly
authors.initials: MA
authors.lastname: Mikhail
authors.forename: Mohan
authors.initials: M
authors.lastname: Varikkara
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010211:Papilledema / Q000188:drug therapy* / Q000469:parasitology*; D011239:Prednisolone / Q000627:therapeutic use; D011739:Pyrimethamine / Q000627:therapeutic use; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis* / Q000188:drug therapy*; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D005938:Glucocorticoids; D017963:Azithromycin; D011239:Prednisolone; D011739:Pyrimethamine