Toxoplasma papillitis without vitritis. a case report in an immunocompetent congolese patient

Abstract

Introduction Unilateral papillitis and neuroretinitis are uncommon manifestations of ocular Toxoplasma gondii infection and pose particularly challenging diagnosis problems. Due to the limited accessibility of healthcare and poor socioeconomic status of a significant proportion of the population in Democratic Republic of the Congo, knowledge of seroprevalence rates for toxoplasmosis remains key to the health system. When Toxoplasma papillitis or neuroretinitis is suspected, vitreous inflammatory reaction is usually present at various degrees on the initial examination as a diagnosis clue. Case report We report the case of a 37-year-old Congolese man who was managed in the University Hospital of Kinshasa, DR Congo, between October 2017 and April 2019 (18 months). The patient”s informed consent was obtained for publication of his data. The patient developed presumed Toxoplasma papillitis with complete absence of vitritis at presentation. He was in good general health and had a known contact with a cat. Ophthalmoscopic examination revealed unilateral inflammation in the left optic disc and peripapillary area coexisting with active juxtapapillary retinochoroiditis that could be confirmed in ocular coherence tomography. A retinochoroiditis scar was present in the right eye. Left visual field was severely altered in automated perimetry. Toxoplasma titer was positive. Anti-HIV (ELISA) antibodies were negative. Rapid and favorable response to appropriate antiparasitic agents was observed without recurrence. Absence of vitritis and retinochoroiditis scar were confirmed during all the follow-up period. Conclusions Papillary toxoplasmosis is rare and potentially serious. Its diagnosis must be sought, even in the absence of vitritis, before taking into account any unilateral papillary edema. Our case report highlights the importance of detailed history and clinical examination to improve diagnostic decision making such as the need for complementary investigations, especially serologic testing, in a country with relatively limited financial resources in public health.