Panuveitis by Coinfection with Toxoplasma gondii and Epstein Barr Virus. Should We Use Antiviral Therapy? - A Case Report.

BACKGROUND: To report the atypical presentation and treatment in a case of Toxoplasma gondii (Tg) and Epstein Barr Virus ( EBV ) intraocular coinfection.

CASE PRESENTATION: A 60-year-old male patient who presented anterior hypertensive uveitis followed by a new finding of a yellowish-white fluffy retinochoroidal lesion in the superior-temporal quadrant. He was initially treated with antiviral therapy without improvement. Next, due to the Tg infection suspicion, anti-toxoplasmic treatment was added, and therapeutic and diagnostic vitrectomy was performed along with intravitreal clindamycin. Polymerase chain reaction (PCR) analysis in intraocular fluids confirmed Tg and EBV coinfection. Then, anti- Toxoplasma oral treatment and antiviral and oral corticosteroids were administrated, achieving improvement.

CONCLUSIONS: In a patient with atypical retinochoroidal lesions, an intraocular fluids PCR should be performed, in addition to the serological laboratories to rule out coinfection, confirm the diagnosis, and establish an appropriate treatment. Coinfection could impact the pathogenesis and prognosis of the disease. Abbreviations: OT: Ocular toxoplasmosis; Tg: Toxoplasma gondii ; EBV: Epstein Barr Virus ; CMV: Cytomegalovirus; HIV: Human Immunodeficiency Virus; HSV: Herpes Simplex Virus ; VZV: Varicella Zoster Virus ; PCR: Polymerase chain reaction; OD: Right eye; OS: Left eye; BCVA: best-corrected visual acuity.