Abstract
A 33-year-old woman underwent bone-marrow transplantation following radiation and chemotherapy for chronic myelocytic leukemia (CML); immunosuppressive therapy was continued for graft-versus-host disease. Five months after successful transplantation, she developed necrotizing retinitis in both eyes with rapid progression over the following weeks. Due to her immunosuppressed state the patient developed pneumonia and died. Postmortem evaluation of the retinal lesions in both eyes disclosed infection byToxoplasma gondii, which was also found in the brain and myocardium. Multiple viable toxoplasmic cysts were observed at the transition zone from a necrotic to a normal retina. Additionally, cysts ofToxoplasma gondii were seen in the adjacent intact retina and in areas of necrosis with almost complete absence of retinal or choroidal inflammation. Toxoplasmosis should therefore be considered along with fungi and viruses in the differential diagnosis of necrotizing retinochoroiditis in immunocompromised patients.
Similar content being viewed by others
References
Akstein RB, Wilson LA, Teutsch SM (1982) Acquired toxoplasmosis. Ophthalmology 89:1299–1302
Bachmann DM, Rodrigues MM, Chu FC, Straus SE, Cogan DG, Macher AM (1982) Culture-proven cytomegalovirus retinitis in a homosexual man with the acquired immunodeficiency syndrome. Ophthalmology 89:797–804
Berger BB, Weinberg RS, Tessler HH, Wyhinny GJ, Vygantas CM (1979) Bilateral cytomegalovirus panuveitis after high-dose corticosteroid therapy. Am J Ophthalmol 88: 1020–1025
Cogan DG (1977) Immunosuppression and eye disease. Am J Ophthalmol 83:777–788
Crawford JB (1966) Toxoplasma retinochoroiditis. Arch Ophthalmol 76:829–832
Franklin RM, Kenyon KR, Tutschka PJ, Sarol R, Green WR, Santos GW (1983) Ocular manifestations of graft-versus-host disease. Ophthalmology 90: 4–13
Frenkel JK, Jacobs L (1958) Ocular toxoplasmosis: pathogenesis, diagnosis and treatment. Arch Ophthalmol 59:260–279
Gloor B, Gratwohl A, Hahn H, Kretschmer S, Robert Y, Speck B, Daicker B (1985) Multiple cotton-wool spots following bone marrow transplantation for treatment of acute leukemia. Br J Ophthalmol 69:320–325
Hirst LW, Jabs DA, Tutschka PJ, Green WR, Santos GW (1983a) The eye in bone marrow transplantation. I. Clinical study. Arch Ophthalmol 101:580–584
Hirst LW, Jabs DA, Tutschka PJ, Green WR, Santos GW (1983b) The eye in bone marrow transplantation. II. Histopathology. Arch Ophthalmol 101:585–590
Hoerni B, Vallat M, Durand M, Pesme D (1978) Ocular toxoplasmosis and Hodgkin's disease; report of two cases. Arch Ophthalmol 96:62–63
Hogan MJ (1958) Ocular toxoplasmosis. Trans Am Acad Ophthalmol Otolaryngol 62:7–37
Holland GN, Gottlieb MS, Yee RD, Schanker HM, Pettit TH (1982) Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome. Am J Ophthalmol 93:393–402
Holland GN, Pepose JS, Pettit TH, Gottlieb MS, Yee RD, Foos RY (1983) Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology 90: 859–873
Jack MK, Jack GM, Sale GE, Shulman HM, Sullivan KM (1983) Ocular manifestations of graft-versus-host disease. Arch Ophthalmol 101:1080–1084
Krick JA, Remington JS (1978) Toxoplasmosis in the adult: an overview. N Engl J Med 298:550–553
Macher A, Rodrigues MM, Kaplan W, Pistole MC, McKittrick A, Lawrinson WE, Reichert CM (1985) Disseminated bilateral chorioretinitis due to histoplasma capsulatum in a patient with AIDS. Ophthalmology 92:1159–1164
McDonnell PJ, McDonnell JM, Brown RH, Green WR (1985) Ocular involvement in patients with fungal infections. Ophthalmology 92:706–709
Nauman GOH (1980) Intraokulare Entzündungen. In: Naumann GOH (ed) Pathologie des Auges. Springer, Berlin Heidelberg New York, pp 88–176
Neuwirth J, Gutman I, Hofeldt AJ, Behrens M, Marquardt MD, Kelsey P, Odel J (1982) Cytomegalovirus retinitis in a young homosexual male with acquired immunodeficiency. Ophthalmology 89:805–808
Newell FW (1982) Acquired cellular immune dysfunction syndrome. Am J Ophthalmol 93: 523–524
Newman NM, Mandel MR, Gullet J, Fujikawa L (1983) Clinical and histological findings in opportunistic ocular infections. Arch Ophthalmol 101:396–401
Newman PE, Ghosheh R, Tabbara KF (1982) The role of hypersensitivity reactions to toxoplasma antigens in experimental ocular toxoplasmosis in nonhuman primates. Am J Ophthalmol 94:159–164
Nicholson DH, Wolchok EB (1976) Ocular toxoplasmosis in an adult receiving long-term corticosteroid therapy. Arch Ophthalmol 94:248–254
O'Connor GR (1974) The uvea. Arch Ophthalmol 91:401–415
O'Connor GR (1975) The uvea. Arch Ophthalmol 93:675–691
O'Connor GR (1983) The role of parasite invasion and of hypersensitivity in the pathogenesis of toxoplasmic retinochoroiditis. Ocul Inflammatory Ther 1:37–46
Palestine AG, Rodrigues MM, Macher AM, Chan CC (1984) Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology 91:1092–1099
Parke DW, Jones DB, Gentry LO (1982) Endogenous endophthalmitis among patients with candidemia. Ophthalmology 89:789–796
Pepose JS, Hilborne LH, Cancilla PA, Foos RY (1984) Concurrent herpes simplex and cytomegalovirus retinitis and encephalitis in the acquired immune deficiency syndrome (AIDS). Ophthalmology 91:1669–1677
Perkins ES (1973) Ocular toxoplasmosis. Br J Ophthalmol 57:1–17
Rao NA, Font RL (1977) Toxoplasmic retinochorioiditis: electronmicroscopic and immunfluorescence studies of formalin-fixed tissue. Arch Ophthalmol 95:273–277
Remington JS, Cavanaugh EN (1965) Isolation of the encysted form ofToxoplasma gondii from human sceletal muscle and brain. N Engl J Med 273:1308–1310
Rodrigues MM, Palestine A, Nussenblatt R, Masur H, Macher AM (1983) Unilateral cytomegalovirus retinochoroiditis and bilateral cytoid bodies in a bisexual man with AIDS. Ophthalmology 90:1577–1582
Rosenthal AR (1983) Ocular manifestations of leukemia. Ophthalmology 90:899–905
Ruskin J, Remington JS (1976) Toxoplasmosis in the compromised host. Ann Int Med 84:193–199
Shulman HM, Sullivan KM, Weiden PL, McDonald GB (1980) Chronic graft-versus-host syndrome in man. Am J Med 69:204–217
Taylor D, Day S, Tiedemann K, Chessels J, Marshall WC, Constable TJ (1981) Chorioretinal biopsy in a patient with leukemia. Br J Ophthalmol 65: 489–493
Uninsky E, Jampol LM, Kaufman S, Naraqi S (1983) Disseminated herpes simplex infection with retinitis in a renal allograft recipient. Ophthalmology 90:175–178
Wilder HC (1952) Toxoplasma chorioretinitis in adults. Arch Ophthalmol 48:127–136
Yeo JH, Jakobiec FA, Iwamoto T, Richard G, Kreissig I (1983) Opportunistic toxoplasmic retinochoroiditis following chemotherapy for systemic lymphoma. Ophthalmology 90:885–898
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pauleikhoff, D., Messmer, E., Beelen, D.W. et al. Bone-marrow transplantation and toxoplasmic retinochoroiditis. Graefe's Arch Clin Exp Ophthalmol 225, 239–243 (1987). https://doi.org/10.1007/BF02175456
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02175456