Title : Atypical presentation of ocular toxocariasis: A case report
Abstract:
Toxocariasis is a parasitosis caused by the accidental ingestion of eggs from a nematode of the Ascarid family (most commonly Toxocara canis). Ocular localization results from the migration of the larva into the eyeball, which is generally benign but can, in some cases, lead to dramatic complications.
Our case illustrates an atypical presentation of ocular toxocariasis, characterized by bilateral involvement and the absence of a visual focus on the fundus.
A 25-year-old patient, with no specific pathological history, from a rural environment in Morocco and a history of contact with animals, was admitted for an etiological workup of ocular involvement consisting of bilateral intermediate and posterior uveitis. The condition manifested as decreased visual acuity and ocular redness. Ophthalmological examination revealed visual acuity of 1/10 in the right eye and 2/10 in the left, bilateral 2-cross hyalitis on the fundus, vascular engorgement in the right eye, and maculopathy in the left eye, with no detectable focus. Retinal angiography showed papillary and post-papillary atrophy and vascular engorgement bilaterally, with a few non-perfused vessels on the right and maculopathy on the left.The etiological workup included a blood count, which revealed no abnormalities, notably no hypereosinophilia. The infectious workup showed positive toxocariasis serology by ELISA, confirmed by Western blot. The diagnosis of ocular toxocariasis was established, and a thoracic X-ray and abdominal ultrasound were performed to search for other visceral involvement, revealing no abnormalities.
The patient was treated with oral corticosteroids (1 mg/kg/day) combined with albendazole (800 mg/day for 14 days), with a clinically favorable evolution.
Ocular toxocariasis is a rare infection. Unilateral involvement is the most frequently described, while bilateral involvement is exceptional. Diagnosis is clinically suspected and confirmed biologically by serology in serum, aqueous humor, or vitreous. Treatment is primarily based on corticosteroids combined with antiparasitic agents.
