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Toxoplasma chorioretinitis diagnosed by histopathology in a patient with AIDS.

PURPOSE
To demonstrate the diagnostic difficulties in cases of retinal necrosis in immunocompromised patients including the potential for false-negative anterior segment sampling and also to emphasize the utility of diagnostic vitrectomy with histopathologic examination.


METHODS
This patient's chart was thoroughly reviewed to present salient features that are relevant to any ophthalmologist attempting to diagnose and treat chorioretinitis. A 38-year-old man with HIV/AIDS who presented with bilateral retinal necrosis. Thorough workup, including multiple samples of anterior chamber fluid for polymerase chain reaction, was negative.


RESULTS
Diagnostic vitrectomy revealed a toxoplasma cyst. Triple therapy stabilized retinitis, although vision did not improve.


CONCLUSION
This case reminds the clinician to consider a broad differential diagnosis for retinal necrosis in immunocompromised hosts and, when serologic and anterior chamber samples are negative, to consider diagnostic vitrectomy for polymerase chain reaction and histopathologic examination.