Diffuse toxoplasmic retinochoroiditis as the initial manifestation of acquired immunodeficiency syndrome

Toxoplasmic retinochoroiditis is an important opportunistic retinal infecti on in human immunodeficiency virus (HIV)-infected patients. It may present as diffuse necrotizing retinochoroiditis instead of a focal lesion and may be the initial manifestation of HIV infection. A 50-year-old heterosexual m an presented with blurred vision in his left eve of 3 months' duration. Fun dus examination revealed diffuse necrotizing retinochoroiditis, mainly at t he posterior pole, with marked vitritis in the left eye. Serologic studies and aqueous fluid antibody titers indicated recent toxoplasmic infection. P ositive enzyme immunoassays (EIA) and Western blot tests proved HIV infecti on. The retinochoroiditis and vitritis improved after an antitoxoplasmic re gimen with trimethoprim-sulfamethoxazole (TMP-SMX). Nonetheless, toxoplasmi c encephalitis developed 6 months after the onset of ocular toxoplasmosis a nd responded well to TMP-SMX. This is the first case of toxoplasmic retinoc horoiditis as the initial manifestation of AIDS reported in Taiwan. We sugg est that Toxoplasma infection should be included in the differential diagno sis of diffuse necrotizing retinochoroiditis and vitritis. We also recommen d that adults with newly diagnosed ocular toxoplasmosis be screened for HIV infection.