Bilateral Jensen Disease In A Healthy Young Lady

Abstract

Toxoplasmic optic neuropathy is rare and usually occurs mono-ocularly. This case report demonstrates a rare presentation of bilateral juxtapapillary retinochoroiditis (Jensen disease) due to toxoplasma infection in a young healthy patient. A 20-year-old lady presented with bilateral painless blurring of central vision for 5 days duration. It was preceded by fever, upper respiratory tract symptoms and headache. There was no history of contact or being scratched by a cat. Visual acuity was counting fingers for the right eye and 6/45 for the left eye. There was presence of relative afferent pupillary defect in the right eye. Optic nerve functions were impaired bilaterally which was severe in the right eye. Both eyes showed the presence of mild anterior segment inflammation and vitritis. Fundus examination revealed juxtapapillary retinochoroiditis bilaterally with swollen optic disc. Optical coherence tomography (OCT) showed presence of intra-retinal and sub-retinal fluid at macular area bilaterally. Serology for anti-toxoplasma Immunoglobulin G (IgG) was positive with titre of 1450 IU/ml. Computed tomography scan (CT scan) of brain and orbit was normal. A diagnosis of bilateral juxtapapillary retinochoroiditis or Jensen disease was made. Oral azithromycin 500 mg daily and guttae prednisolone 4 hourly for 6 weeks was commenced. Oral prednisolone 50 mg daily (1 mg/kg/day) was added after completion of 1 week of antibiotic and was tapered down within 5 weeks. There was improvement of vision as early as 3 weeks post initiation of the treatment. Upon 6 weeks completing the treatment, her vision has improved to 6/7.5 on both eyes with resolution of optic disc swelling and sub-retinal fluid. Early recognition and initiation of treatment in toxoplasma infection associated with juxtapapillary retinochoroiditis usually result in good visual prognosis.