PMC8110419_01
Clinical features of the patient at the time of presentation. Bilateral angular cheilitis (a), posterior synechiae, and keyhole-shaped pupil (b), In the right eye inferonasal to the optic disc, an annular white patch centered with a pigmented scar is seen. White subretinal bands are extending from the lesion. The size of the lesion is about three-disc diameter, and the adjacent retina is detached (c). Macular optical coherence tomography of the right eye demonstrates evidence of vitritis, detached posterior hyaloid, and a fine epiretinal membrane nasal to the fovea (d).
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fig1
At the time of the presentation, she mentioned anorexia and losing 10 kg in the past three months, and signs of anemia like paleness of face skin, bed nails, and bilateral angular cheilitis were observed (Figure 1(a)). Slit-lamp examination revealed granulomatous keratic precipitates (KPs) distributed in Arlt's triangle, 2+ cells in the anterior chamber, and a relatively broad-based PS causing a keyhole appearance in the pupil (Figure 1(b)). Some fibrous bands were emanating from the lesion, and the retina around this region was detached with considerable extension towards the superior, nasal, and inferior periphery, while no breaks could be appreciated (Figure 1(c)).
Magnetic resonance imaging (MRI): T1 with contrast in coronal (a) and axial planes (b, c): multiple ring-enhancing lesions in the left and right cerebral cortices.
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fig2
Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices (Figure 2).
Montage fundus photography of the patient's right eye three months after initiation of antitoxoplasmosis treatment and HAART shows complete retinal reattachment. A retinal fold extends from the lesion to the nasal periphery. Subretinal exudates are seen in the inferior area of the disc and around the macula.
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fig3
Two months after initial presentation, vitreous inflammation decreased substantially, subretinal fluid gradually resolved, and the uncorrected visual acuity improved to 20/100 (Figure 3).