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Clinical Summary

A 19-year-old woman had right eye pain with bluriness and floaters for two weeks. On examination, her vision in this eye was 20/60. Slit-lamp biomicroscopy (A) revealed a large, white-yellow lesion just beneath the superotemporal arcade, and swelling of the optic nerve. Fluorescein angiography (B) showed late leakage from the disc and the lesion consistent with papillitis and active inflammatory changes along the retinal venules, respectively A presumptive diagnosis of toxoplasmosis retinitis was made.

Optical Coherence Tomography

A vertical scan (C) through the lesion exhibited a well-demarcated region of enhanced backscattering from the superficial retina consistent with inflammation in the inner retinal layers. The increased reflectivity from these layers shadowed the backscatter signal from the deeper retina and choroid. The involvement of the neurosensory retina was consistent with the predilection of toxoplasmosis for neural tissue. The retina appeared thickened throughout the lesion, although the retinal pigment epithelium could not be directly visualized in the image. Significant backscatter was also observed anterior to the retina, indicative of the migration of inflammatory cells into the vitreous. A partial detachment of the posterior vitreous face was noted throughout the inferior aspect of the lesion.

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