A case of ocular toxoplasmosis presenting with neuroretinitis

A 33-year-old female patient, who followed up in an external center with the diagnosis of optic neuritis 2 years ago, had complaints of decreased vision and headache for 1 week. In our examination, visual acuity was counting fingers from 2 m in the right eye and 1.0 in the left eye with a Snellen chart. The bilateral anterior segment was normal in the slit-lamp ex-amination. Color vision was 0/12 in the right eye and 12/12 in the left eye. In dilated fundus examination, optic nerve head edema was present in the right eye, while the optic nerve, macula, and retina of the left eye were normal. In the visual field, an inferior arcuate visual field defect was observed in the right eye. Anti-Toxoplasma immunoglobulin M resulted in 1240 IU/mL (positive) and immunoglobulin G 90.5 IU/mL (positive). Optical coherence tomography showed pigment epithelial detachment adjacent to the optic disc. Trimethoprim/sulfamethoxazole 800/160 mg 2 × 1, azithromycin 1000 mg loading, followed by 500 mg 1 × 1 (1 week) was started. On the 3rd day of the treatment, a prednisolone 1 mg/kg/day weekly reduction regimen was started. There was a macular star appearance with hard exudates in the macula with a rapid recovery with treatment. At the 6th-month follow-up, visual acuity was 0.5 in the right eye and 1.0 in the left eye, while the anterior segment slit-lamp examination was normal. In dilated fundus examination, the temporal part of the optic disc was pale and macular hard exudates were present in the right eye; and the left was normal.