Immunology Case Report #2

Immunology Case Reports are posted as a service of the National Eye Institute's Laboratory of Immunology to encourage dialog and collaboration between clinicians and researchers with an interest in ocular immunology and immunopathology. Your medical opinions on this case are welcome will be published on this page.

Please send your comments to:

Chi-Chao Chan, M.D.
ccc@helix.nih.gov

Janine Smith, M.D.
jmas@box-j.nih.gov

Presenting Physician

Sam Lertsumitku
Australia

A 65 year old Vietnamese lady who had just returned from Vietnam (6 months holiday back home) presented with a sudden drop in vision and mild vitritis. The fundus picture follows. Fluorescein angiography showed staining subretinal lesion. She is otherwise well. The other eye showed some drusen in the macula, but is otherwise quiet. What do you think? Is it just a granuloma or a CNV from toxoplasmosis (that's the diagnosis from the referring ophthalmologist). I gave her Clindamycin and Sulphadiazine for 1 month. She improved with drying of subretinal fluid and vision improved from CF to 20/80. I did not give her any steroid since she was getting better.

The retinal elevation improved with Clindamycin and Sulphadiazine treatment for 6 weeks. But the "granuloma" persists. VA improved from CF to 6/24.