A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfectio
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CASE REPORT
Open Access
A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfection: a case report Juliana Muñoz-Ortiz1,2, Olga Lorena Rubio-Romero2, Maria Cecilia Cedeño3, Karla Arteaga-Rivera1 and Alejandra de-la-Torre2*
Abstract Background: We report a case of white circular spots of iridian atrophy, which we will call “polka dots” pattern, as a rare ophthalmological finding associated with uveitis secondary to varicella-zoster virus and Toxoplasma gondii coinfection in a male patient in Bogotá, Colombia. Case presentation: We present de case of a 53-year-old Colombian male patient with a diagnosis of anterior uveitis in his left eye due to varicella-zoster virus and Toxoplasma gondii coinfection documented by polymerase chain reaction analysis. He presented with multiple areas of superficial white circular spots of iridian atrophy in 360º, some with deeper atrophy where the stroma fibers were visualized and only a small punctate defect of transillumination was evident. This rare pattern of iridian atrophy has not been previously described in cases of uveitis in the literature. Conclusions: This is the first case reporting the findings of superficial “polka dots” pattern iridian atrophy in 360° secondary to anterior uveitis due to the coinfection of a virus and a parasite. The identification of similar clinical cases may lead to early initiation of systemic treatment in these patients. Keywords: Iridian atrophy, Uveitis, Coinfection, Varicella-zoster, Toxoplasma gondii, Polymerase chain reaction
Background Infectious uveitis is the leading cause of uveitis in Colombia. Toxoplasma gondii (Tg) is the most frequent agent involved in 39.8% of these cases [1], however, ~ 7.5% of ocular toxoplasmosis cases can coexist with other infectious agents, e.g. Mycobacterium tuberculosis, cytomegalovirus (CMV), and varicella-zoster virus (VZV) [2]. Clinical manifestations of ocular toxoplasmosis usually include necrotizing retinochoroiditis, vitritis, optic neuritis, and less frequently, anterior hypertensive uveitis [3]. * Correspondence: [email protected] 2 NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia Full list of author information is available at the end of the article
On the other hand, viral agents uveitis cause a broad clinical spectrum of clinical findings, including ocular hypertension, diffuse stellate keratic precipitates, the presence of iridian atrophy (IA) [4], retinitis, macular edema, scarring, and retinal pigment epithelium hyperplasia [5]. Iris stromal atrophy in uveitis is characterized by sectorial, spiral, or diffuse damage of the iris with transillumination defects, or rarely, massive IA with gross sphincter damage [4]. IA has been associated with iris perfusion disorders [6] and/or viral invasion of the pigment epithelium [4]. Although there are few reports of different infectious etiologies, such as toxocariasis [7] and toxoplasmosis [8] associate
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