Acute acquired toxoplasmic retinochoroiditis in a patient with anterior uveitis, amplified by immunosuppressive therapy.

BACKGROUND: A 24-year-old immunocompetent man with anterior uveitis developed a bilateral multifocal retinochoroiditis after an acute febrile multisystemic illness. HISTORY AND SIGNS: Because of his history of idiopathic uveitis the multisystemic illness was treated with oral prednisone. When a retinochoroiditis occurred cyclosporine was added. This was followed by an extensive flare-up of the retinochoroiditis. The diagnosis of toxoplasmosis was then established by a positive polymerase chain reaction (PCR) from aqueous humour and confirmed by isolation of the parasite in several organs. THERAPY AND OUTCOME: On the base of kept frozen sera the acute febrile episode was found to be an acquired toxoplasmosis. On re-examination all evidence of pre-existing Fuchs' uveitis was gathered. The immunosuppressive therapy was discontinued and the patient was kept under anti-toxoplasmic maintenance therapy for 1 year without recurrence of the retinochoroiditis.
CONCLUSIONS: The case illustrates a possible consequence of immunosuppressive therapy in infection with toxoplasmosis and the importance of the diagnosis of a pre-existing noninfectious uveitis.