Bilateral Jensen Disease In A Healthy Young Lady

Ghani Siti-Ilyana, Koh Yi-Ni, Embong Zunaina


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.



Jensen disease, Juxtapapillary retinochoroiditis, Ocular toxoplasmosis.

Full Text:



Alipanahi R, Sayyahmelli S. Acute Papillitis in Young Female with Toxoplasmosis. Middle East Afr J Ophthalmol. 2011; 18(3):249-251. doi:10.4103/0974-9233.84060.

Eckert GU, Melamed J, Menegaz B. Optic nerve changes in ocular toxoplasmosis. Eye. 2007; 21(6):746–751.

Klaren VN, Kijlstra A. Toxoplasmosis, an overview with emphasis on ocular involvement. Ocul Immunol Inflamm. 2002; 10:1–26.

Park YH, Nam HW. Clinical Features and Treatment of Ocular Toxoplasmosis. Korean J Parasitol. 2013; 51(4):393-399. doi:10.3347/kjp.2013.51.4.393.

Wilking H, Thamm M, Stark K, Aebischer T, Seeber F. Prevalence, incidence estimations, and risk factors of Toxoplasma gondii infection in Germany: a representative, cross-sectional, serological study. Sci Rep. 2016; 6:22551. doi:10.1038/srep22551.

Banta JT, Davis JL, Lam BL. Presumed toxoplasmic anterior optic neuropathy. Ocul Immunol Inflamm. 2002; 10(3):201–211.

Jensen, E. Retinochoroiditis Juxta¬papillaris. Arch Ophthal. 1908; 69: 41.

McAuley JB. Congenital Toxoplasmosis. J Pediatric Infec Dis Soc. 2014; 3(Suppl 1): S30-S35. doi:10.1093/jpids/piu077.

Yamamoto JH, Vallochi AL, Silveira C, Filho JK, Nussenblatt RB, et al. Discrimination between patients with acquired toxoplasmosis and congenital toxoplasmosis on the basis of the immune response to parasite antigen. J Infect Dis. 2000; 181(6):2018-22.

Elkins BS, Holland GN, Opremcak EM. Ocular toxoplasmosis misdiagnosed as CMV retinopathy in immunocompromised patients. Ophthalmol. 1994; 101:499-507.

Harper TW, Miller D, Schiffman JC, Davis JL. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol. 2009; 147:140-147. e2. doi: 10.1016/j.ajo.2008.07.043.

Rothova A, de Boer JH, Ten Dam-van Loon NH, Postma G, de Visser L, et al. Usefulness of aqueous humor analysis for the diagnosis of posterior uveitis. Ophthalmology. 2008; 115(2):306-311. doi:10.1016/j.ophtha.2007.05.014.

Holland GN. Ocular toxoplasmosis: A global reassessment. Part II: disease manifestations and management. Am J Ophthalmol. 2004; 137(1):1–17.

Eyles DE, Coleman N. Antibiotics in the treatment of toxoplasmosis. Am J Trop Med Hyg. 1953; 2(1):64-69.

Rothova A, Bosch-Driessen LE, van Loon NH, Treffers WF. Azithromycin for ocular toxoplasmosis. Br J Ophthalmol. 1998; 82(11):1306-1308.

Balaskas K, Vaudaux J, Boillat-Blanco N, Guex-Crosier Y. Azithromycin versus sulfadiazine and pyrimethamine for non-vision threatening toxoplasmic retinochoroiditis: a pilot study. Med Sci Monit. 2012; 18(5): CR296-302.

Bosch-Driessen EH, Rothova A. Sense and nonsense of corticosteroid administration in the treatment of ocular toxoplasmosis. Br J Ophthalmol. 1998; 82:858–60.

Oray M, Ozdal PC, Cebeci Z, Kir N, Tugal-Tutkun I. Fulminant ocular toxoplasmosis: the hazards of corticosteroid monotherapy. Ocul Immunol Inflamm. 2016; 24(6):637-646. doi:10.3109/09273948.2015.1057599.

Holland GN, Lewis KG: An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol. 2002; 134(1):102-114.

Copyright (c) 2018 Journal of Biomedical and Clinical Sciences (JBCS)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Journal of Biomedical and Clinical Sciences (JBCS) publishes original research articles, short review, short communication, case reports, quiz and letter to editor that covering the areas of fundamental aspects of biomedical and clinical sciences, from pre-clinical towards translational research and their applications in medicine, dentistry and healthcare management. JBCS aims to provide a platform for basic science and clinical researchers to communicate and share their research findings to the advancement of technologies in biomedical and clinical sciences by providing maximum access to scholarly communication.

Flag Counter           


                                              Copyright © 2016 AMDI Publisher, Universiti Sains Malaysia.
Disclaimer : This website has been updated to the best of our knowledge to be accurate. However, Universiti Sains Malaysia shall not be liable for any loss or damage caused by the usage of any information obtained from this web site.
                                            Best viewed: Mozilla Firefox 4.0 & Google Chrome at 1024 × 768 resolution.