Ocular toxocariasis masquerading as toxoplasmosis: a case report and literature review

Abstract Background: False-negative and false-positive results in Toxoplasma serology are possible, and this could be misleading. Here, we report the case of a boy with Toxocara-associated panuveitis who was initially treated for toxoplasmosis owing to false-positive Toxoplasma immunoglobulin M (IgM) serology. Case Presentation: A nine-year-old boy presented with intermittent headaches and blurred vision in the left eye. Close contact with domesticated animals was remarkable in the patient’s history. Upon examination, vision was ۲۰/۴۰۰ in the left eye. Slit-lamp examination revealed anterior chamber cells and flare without keratic precipitates, with vitreous cells and veils, optic disc edema, and a blurred fundus appearance. A systemic investigation revealed the presence of anti-Toxoplasma IgM antibodies. Treatment was initiated using topical cycloplegic and corticosteroid eye drops, in addition to oral trimethoprim/sulfamethoxazole. Oral corticosteroids were also administered. As the inflammation resolved, an inferior tractional detachment was detected on fundus examination, leading to the ultimate diagnosis of ocular toxocariasis. An enzyme-linked immunosorbent assay was positive for serum Toxocara antibodies. A fourteen-day course of oral albendazole was ordered by the pediatric infectious disease service because of the concern for visceral larva migrans, while topical eye drops were continued and oral prednisone was tapered. One month later, visual acuity in the left eye had improved to ۲۰/۷۰. The anterior chamber inflammation resolved; however, some vitreous cells and optic disc edema persisted. The inferior tractional detachment was much better visualized, and a peripheral granuloma was observed. Four months later, without any oral or topical medications, the patient’s visual acuity had improved to ۲۰/۳۰ and his eye had no active inflammation. The patient has been followed up for two years and has never developed any other lesions. Conclusions: False-positive results on Toxoplasma serology and diffuse vitritis from toxocariasis that limited retinal visualization complicated the initial diagnosis in this case. In diagnosing the etiology of uveitis, ocular examination and detailed history taking should be emphasized, as laboratory results may be misleading. Keywords: toxocaras toxocara cani toxoplasma gondii infection ocular toxoplasmosis albendazole monohydrochloride steroid cycloplegic uveitides panuveitis retinal detachments