A typical bilateral Toxoplasma retinochoroiditis in a bone marrow transplant patient with negative serum titers

A 27-year-old male with chronic myelogenous leukemia with history of bone marrow transplantation presented with floaters in his right eye. Fundus exam showed bilateral, multifocal retinochoroiditis with subsequent development of a mild vitritis. Serum cytomegalovirus and toxoplasmosis antibody titers and syphilis screen were negative. Aqueous polymerase chain reaction (PCR) analysis revealed the presence of Toxoplasma gondii DNA OU. Clindamycin (1.0 mg/0.1 mL) was injected bilateral intravitreal OU twice at 4 days apart with subsequent resolution of retinochoroiditis.When evaluating retinochoroiditis in an immunocompromised patient, one must keep a high index of suspicion for atypical presentations of well-known disease entities. Aqueous and vitreous samples for PCR can be useful in obtaining an accurate diagnosis and therefore provide appropriate management for the patient. Intravitreal clindamycin is an option for treatment in these patients.An immunocompromised patient presented with floaters and fundus lesions suspicious for infectious retinochoroiditis vs. chronic myelogenous leukemia (CML) relapse. Despite negative serum toxoplasmosis titers, an aqueous polymerase chain reaction (PCR) analysis revealed ocular toxoplasmosis bilaterally and the patient responded to therapy. We discuss clinical presentation, diagnostic workup, and various treatment options in the management of Toxoplasma retinochoroiditis. All research for this brief report was done with appropriate ethical approval from the Albert Einstein College of Medicine Institutional Review Board and informed consent was obtained from the subject.A 27-year-old male with history of CML on remission since treatment with imatinib, chemoradiation, and allogenic bone marrow transplantation 1 year prior to consultation and with active and recurrent acyclovir-resistant herpes simplex stomatosis presented with a 2-day history of floaters in his right eye. Patient’s medications included several immunosuppressive ag