PMC9284721_01
Initial presentation. Optical coherence tomography (OCT) of the right (OD) and left (OS) macula, demonstrating a normal retinal architecture of the macula and fovea in both eyes.
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F1
Dilated fundus examination revealed a small inferotemporal diffuse granular white deep retinal lesion (Figure 1 (Fig. 1), Figure 2 (Fig. 2)) and a superonasal retinal white lesion along the vascular arcade (Figure 1 (Fig. 1)) that was clinically consistent with viral retinitis in the context of a CMV-positive blood sample and the patient's immunocompromised state.
Initial presentation. (A) Color fundus montage photography of the posterior retina of the right eye. Note the white granular retinal lesion. (B) Optos ultra-widefield photography of the right fundus one weeks after the initial presentation demonstrating both supranasal and infratemporal areas of retinitis. (C) Ultra-widefield photography of the right fundus two weeks after the initial presentation demonstrating progression of the lesions despite systemic antivirals. (D) Further progression three weeks after initial presentation. (E) OCT over the edge of the infratemporal area of retinitis demonstrating focal vitritis, intraretinal fluid and retinal necrosis.
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F2
Dilated fundus examination revealed a small inferotemporal diffuse granular white deep retinal lesion (Figure 1 (Fig. 1), Figure 2 (Fig. 2)) and a superonasal retinal white lesion along the vascular arcade (Figure 1 (Fig. 1)) that was clinically consistent with viral retinitis in the context of a CMV-positive blood sample and the patient's immunocompromised state. However, over the next three weeks, the patient presented with progression of these retinal lesions with associated hemorrhages in the inferotemporal and superonasal quadrants in the peripheral retina of the right eye (Figure 2A (Fig. 2) (week 1), Figure 2B (Fig. 2) (week 2)). Two weeks later, fundus exam of the right eye demonstrated a further interval progression of the patient's retinal lesions with subtle focal vitritis and hemorrhage associated with the superonasal retinitis (Figure 2B-C (Fig. 2)).
Progression despite treatment. (A) Optos ultra-widefield photography of the right fundus four weeks after the initial presentation demonstrating both supranasal and infratemporal areas of retinitis with a magnified view of the superonasal lesion demonstrating a progression of the retinitis (B). The arrow in (A) denotes a new satellite area of retinitis. (C) Optos ultra-widefield photography of the right eye and (D) left eye demonstrating the early response to the first round of intra-vitreal clindamycin and foscarnet with the lesion margins beginning to show healing. (E) OCT analysis of the macula demonstrating thickening of the nasal macula in the right eye with distortion of the architecture of the retina. The left eye remains normal.
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F3
There was a new peripheral inferotemporal retinochoroidal lesion in the left eye (Figure 3A-B (Fig. 3)).
Resolution and scarring. (A) Optos ultra-widefield photography of the right eye and (B) left eye demonstrating the residual retinochoroidal scars in both eyes following successful treatment of toxoplasmosis. (C) OCT analysis demonstrating stable ERM with retail wrinkling and mild CME in the right eye and normal macula of the left eye. (D) OCT analysis of the right eye superonasal scar demonstrates a significant ERM with thickening and scarring. There is also significant retinochoridal atrophy with overlying fibrosis of the vitreous.
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F4
Peripheral examination of both eyes revealed quiescent lesions (Figure 4 (Fig. 4)). The retinochoroidal lesions in both eyes were quiescent with stable scars (Figure 4A-B (Fig. 4)).