Atypical Form of Ocular Toxoplasmosis

We present the case of a girl, aged 7 years, from rural area, admitted to our clinic with frontal and occipital headache and intermittent ocular pain, which started three weeks before admission; no pathologic antecedents. When admitted, weight=51 kg, height=124 cm (BMI=36.16), no fever but with modified general state, excessive subcutaneous cellular tissue, normal cardio-pulmonary and digestive state, without meningeal symptoms. BP= 90/62 mmHg, HR= 80 b/min.; eye fundus examination at admission: both eyes - papillae with a faded, prominent contour/lineament, multiple hemorrhages with a peripapillary location and several soft exudates (RE > LE), maculae with preserved reflex; diagnosis: papillary edema. Head computed tomography, normal cerebral and cervical spine NMR, and normal aspect in hypophysis NMR; hemogram, renal and hepatic investigations, ionogram, glycaemia – normal values; the TORCH test pointed out increased values for IgM Toxoplasma 1.24 UI/ml (N= 0-0.8) and for IgG Toxoplasma 36.31 UI/ml (n=0-10). We excluded: cerebral edema, malformations, hypophysis or optical chiasma tumors, Arnold-Chiari malformation. We decided for the ocular toxoplasmosis diagnosis and the patient was sent to the infectious disease physician for an antiparasitic treatment. Before starting it, the patient no longer complained of headaches and the eye fundus exam was normal, most likely because of seroconversion, with a decrease of IgM and an increase of IgG Toxoplasmosis, as shown by the TORCH test. The patient remained in our clinic’s evidence, returning for regular ophthalmologic examination, and with a good evolution.