Description
A 52-year-old man was referred for an ophthalmological opinion after becoming generally unwell and developing reduced vision in the left eye. He had had a cardiac transplant 6 months prior and was being followed up on an outpatient basis. Unfortunately, he was too unwell to be transferred to the ophthalmology department; bedside examination in intensive care found vision to be 6/60 with two retinal lesions and vitritis in the left eye.
Infection screening found PCR positivity for toxoplasmosis and cytomegalovirus (CMV). A myocardial biopsy revealed intramyocardial cysts consistent with toxoplasmosis infection. The recipient was seronegative for toxoplasmosis, but the donor was positive. Both the donor and recipient were seropositive for CMV. The patient had received pretransplant prophylaxis treatment but this was stopped before the course finished due to intolerance. Clinically, the findings were not fully consistent with either ocular toxoplasmosis or CMV infection.
With the patient's consent, funduscopic documentation was...
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