Systemic Disorders With Optic Nerve and Retinal Findings

This 25-year-old man presented to the eye service with a history of 3 days of decreased vision OD. His past medical history was unremarkable. His examination showed acuities of 20/25 OU, with intact color plates, a 0.3 log unit of RAPD OD, and an inferior arcuate scotoma. The photos (Images 95_42, 95_43, and 95_44) show his vitreous of the right eye. MRI of the orbits and head was normal, and a spinal tap showed protein = 45 mg/dl, with 0 white cells; the cryptococcal antigen was negative, IgG = 3.8 mg/dl; cytology, cultures, and oligoclonal banding were all negative. Serologic evaluation included a normal Lyme by Western blot; serum protein electrophoresis was negative; CBC, ACE, and RPR were all normal. The toxoplasmosis titer was IgG > 200 (normal < 25 IU/ml) and the AMV IgG = 2.9 u/ml (<1.0). He was treated with clindamycin, Bactrim, and Daraprim for presumed toxoplasmic juxtapapillary choroiditis. Pair with 95_43 and 95_44.