Purpose

To present a case of congenital ocular toxoplasmosis presenting as vitritis and choroidal neovascular membrane

Methods

Case report

Results

A 25-day old female managed as a case of Cholestatic jaundice secondary to TORCH infection was referred to the clinic for baseline evaluation. On examination, the best-corrected visual acuity (BCVA) was squints to bright light. Anterior segment and fundus examination of the right eye was unremarkable. Fundus examination of the left eye showed hazy media due to grade 4 vitritis and a membrane overlying the optic disc. On B scan ultrasound, there is diffuse echogenicity in the posterior cavity with low acoustic reflectivity corresponding to vitreous inflammation. Serologic investigations showed elevated cytomegalovirus IgG and toxoplasma IgG titers. A presumed diagnosis of congenital ocular toxoplasmosis was made so 0.4 ml Clindamycin four times a day and 4ml Prednisone twice a day was given. With no change of vitritis after 2 weeks of treatment, pars plana vitrectomy was done to potentially save the vision. 1 week post vitrectomy, fundus examination showed no vitritis with a solitary well defined round yellow-gray elevated lesion about 2 1/2disc diameter in size on the posterior pole with overlying vessels peripherally, possibly a choroidal neovascular membrane. The medications were continued. The patient’s parents were advised of possible bleeding secondary to the choroidal neovascular membrane.

Conclusions

Vitritis can be a presenting sign of ocular toxoplasmosis in the newborn. Choroidal neovascular membrane secondary to the active retinitis can occur as a complication. Prompt management is recommended in order to save the vision to prevent amblyopia in the future.