Abstract

P 244

Chorioretinitis in a case of multiple infections

Barleon L., Hoffmann E. M.
Universitäts-Augenklinik Mainz

Objective: A 37-year-old female patient with sudden, painless reduction of visual acuity in the right eye was diagnosed with chorioretinitis. Beside infections, other reasons for this disease are hereditary immune mediated disease, pharmaceuticals or trauma. The most frequent infectious causes of chorioretinitis are toxoplasmosis, CMV, HIV, lues, TBC, Lyme disease, helminths and candidiasis.
Results: The anterior part of the right eye revealed some non-pigmented cells in the anterior chamber. The vitreous contained sporadic cells and a macular and retinal oedema, confirmed by OCT and angiography. The foveal region showed a circa 4 mm large, whitish, fluffy infiltration. In the medical history we found a disposition of abcesses on different parts of the body and an acute sinusitis maxillaries left. The examinations revealed a positve IgM-toxoplasmosis, positive IgM-CMV and positive IgM-borreliosis. Lues, TBC and HIV serology were negative. The neurological examination, an MRT of the cranium and a lumbar puncture were without pathological findings. The differential haemogram did not show any pathological changes either. Despite a reduction of IgG in the serum (6.22 g/L; norm: 7-16 g/L) the haematological analysis could not provide an informative basis for a congenital immune defect. The therapy was simultaneous with intravenous Ceftriaxone, Pyrimethamine, and Sulfadiazine. Subsidiary, we substituted folic acid. Under this therapy, a slow decrease in size and prominence of the infiltrate was noted. The visual acuity did not change significantly.
Conclusions: The reasons for chorioretinitis are difficult to investigate. Because of the discrete vitreous inflammation our patient possibly had a toxoplasmosis infection. In case of coexisting positive IgM-toxoplasmosis, positive IgM-CMV and positive IgM-borreliosis a polyclonal IgM- stimulation should be born in mind for differential diagnosis.

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