Neuro-ophthalmological features due to cerebral toxoplasmosis in an immunocompetent patient: A rare case

Toxoplasmosis affects 25–30% of the global population with South America and Asia having the highest known infection rates. The reactivation of toxoplasma gondii cyst can be symptomatic in immunodeficient people but rarely in immunocompetent people. A 38-year-old woman was reported to have experienced restricted visual field since August 2023 with significant weight loss. The result of the HFA test showed hemianopia homonymous sinistra, but normal funduscopic examination. No neurologic deficits were discovered. Visual Evoked Potential (VEP) found bilateral demyelinating lesion on the visual pathway. Multiple lesions were found on Brain MRI. IgM Toxoplasmosis was positive and the result for HIV was negative. Symptoms improved after one month of cotrimoxazole once a day. A follow-up MRI showed decreased edema on the lesions. This report shows immunocompetent people can have atypical manifestation of cerebral toxoplasmosis thas has an excellent outcome on single anti-toxoplamosis treatment after one month. Our diagnosis was based on a detailed history and strong radiological and serological results.