TOXOPLASMA RETINOCHOROIDITIS WITH INVOLVEMENT OF 2ND AND 3RD CRANIAL NERVE: A RARE CASE REPORT
A 30 year Hindu female presented with headache & blurring of vision of left eye (LE) for 2 days. She had a history of contacts with cats in her house. O/E: - VA- HM+ in LE. Restricted ocular movements (adduction, elevation and depression of LE) with mild ptosis were present. Pupil of LE was sluggishly reacting to light. Posterior segment examination revealed an isolated choroiditis patch along superior temporal arcade in paramacular area. Investigation showed ESR- 40, Toxoplasma IgG titre +ve (117). Ocular Coherence Tomography (OCT) showed hyperreflective patch along superior temporal arcade. MRI showed mild diffusely thin left optic nerve with prominent perioptic CSF space. PCR of aqueous humor was +ve for toxoplasma. Patient was treated with oral Trimethoprim with Sulfamethoxazole BD for 7 days. Oral Methylprednisolone 16mg 3 times/ day was given after 2 days of starting of antibiotic & tapered over 3 weeks.1mg of Vit- B12 was given orally for 3 week. On follow up after 1 week VA improved to 20/40. Ptosis improved and ocular movements were restricted only in extreme gazes. On OCT, size of the patch decreased after t/t. On follow up after 2 week, VA was 20/30, no ptosis, ocular movements were full and free in all direction. No identifiable patch was present on fundus examination and OCT. Conclusion- It’s a rare case of toxoplasma choroiditis with involvement of 2nd and 3rdcranial nerve. Complete recovery occurred after timely appropriate treatment.