Título

REACTIVATION OF OCULAR TOXOPLASMOSIS FOLLOWING SARS-COV-2 INFECTION

Objetivo

To report a case of ocular toxoplasmosis reactivation after COVID-19 disease.

Relato do Caso

Caucasian female patient. At 19 years, suffered a retinochoroiditis episode in the right eye, evolving to visual loss. Laboratory exams confirmed Toxoplasma gondii etiology. At 37 years, she was diagnosed with COVID-19 after symptoms of mild dyspnoea and conjunctival hyperemia. She performed home isolation for 10 days, taking azithromycin, paracetamol, dipyrone and ibuprofen. After 3 weeks, she developed fever, burning in both eyes and floaters in the right eye. We requested Chemiluminescence tests and the patient was seroreactive to anti-Toxoplasma gondii antibodies (IgG+). At ophthalmological exams, her best corrected visual acuity was 20/200 in the right eye and 20/20 in the left eye. Biomicroscopy showed clear conjunctiva, transparent cornea with keratic precipitates in the endothelium and anterior chamber flare 2+ in the right eye. Retinography illustrated active retinochoroiditis lesions in the periphery of the right eye (Figure A). At the posterior pole of the right eye, nitidus foveal contour (Figure B) raised suspicion of macular hole, confirmed by optical coherence tomography (Figure C and D).

Conclusão

Ocular manifestations of toxoplasmosis can occur in acquired disease as a result of acute infection or recurrence. The possibility of reactivation of toxoplasmic retinochoroiditis due to host immunosuppression has been established since the 1980s. In the early stage of COVID-19, a large number of proteins associated with the immune response are down-regulated, suggesting that there is an immune suppression in COVID-19 patients. We believe that this mechanism happened in our patient, considering that there weren't previous recidivisms before the one reported. In our knowledge, this is the first reported case of toxoplasmosis reactivation after SARS-CoV-2 infection. Further studies are needed to prove the association proposed.