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Recurrent and de novo toxoplasmosis chorioretinitis following coronavirus disease 2019 infection or vaccination

Paper Presentation | Présentation d'article
11:20 AM, Friday 10 Jun 2022 (10 minutes)

Authors: Mélanie Hébert, Soumaya Bouhout, Marie-Josée Aubin.
Hôpital du Saint-Sacrement, CHU de Québec – Université Laval, Hôpital Maisonneuve-Rosemont.

Author Disclosure Block: M. Hébert: None. S. Bouhout: None. M. Aubin: None.

Abstract Body:

Purpose: To report cases of toxoplasmosis chorioretinitis following coronavirus disease 2019 (COVID-19) infection or vaccination.

Study Design: Retrospective observational case series.

Methods: This study reports results from the COVID-19 Eye Registry (COVER). COVER is a national Canadian registry recording ocular manifestations following COVID-19 infection or vaccination. Patients who were reported between December 2020 and September 2021 with new or recurrent toxoplasmosis chorioretinitis are presented. Basic demographic data, type of vaccine (i.e., Moderna Spikevax® (ModernaTX, Inc.), Pfizer-BioNTech Comirnaty® (BioNTech Manufacturing GmbH), or AstraZeneca Vaxzevria® (AstraZeneca Canada Inc and Verity/SII (COVISHIELD)), timing of presentation relative to COVID-19 infection or vaccination, clinical presentation, management, and final visual acuity (VA) are reported.

Results: Three eyes of three patients (mean age ± standard deviation: 51 ± 10.4 years) were reported. A 53-year-old male with no history of toxoplasmosis presented 25 days following the diagnosis of a non- complicated COVID-19 pneumonia with a unilateral white chorioretinal lesion in the posterior pole associated with vitritis, consistent with ocular toxoplasmosis, and a visual acuity (VA) of 20/70.
Toxoplasmosis immunoglobulin (Ig) G was positive (97.80 g/L), toxoplasmosis IgM was negative. Resolution was achieved with a course of topical prednisolone acetate 1% (PF) with oral clindamycin and trimethoprim/sulfamethoxazole over two months. He later presented a relapse of chorioretinitis 8 days following a first dose of Pfizer-BioNTech vaccine, which resolved with the same therapeutic regimen. His final VA was 20/40. A prophylactic course of trimethoprim/sulfamethoxazole was given for his second dose and no recurrence was observed. Two other patients presented with unilateral panuveitis and active chorioretinal lesions following COVID-19 vaccination. The first was a 58-year-old female who presented 94 days following a first done of Pfizer-BioNTech vaccine with a VA of 20/50. The second was a 39-year-old female who presented 17 days after a second dose of Moderna vaccine with a VA of 20/100. This patient was known for toxoplasmosis chorioretinitis since 2011 with no relapse since 2016. Both were treated with topical PF, oral clindamycin and trimethoprim/sulfamethoxazole, and a short course of oral prednisone. Final VA was 20/20 for both patients. The first patient received a second vaccine dose with prophylactic trimethoprim/sulfamethoxazole and had no relapse.

Conclusions: Following COVID-19 infection or vaccination, patients may be at risk for new or relapsing toxoplasmosis chorioretinitis. Physician should be aware of this and may propose prophylactic antibiotics for future vaccine doses in patients known for ocular toxoplasmosis.

CHU de Québec - Université Laval
Ophthalmology Resident
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