Ocular and disseminated toxoplasmosis with toxoplasmic myocarditis
B. Obtain aqueous sample for cultures and polymerase chain reaction
On presentation, an aqueous sample was obtained and sent for cultures and polymerase chain reaction (PCR) (answer B). The focal, white, macular lesion with moderate overlying vitritis resembled the “headlight-in-the-fog” appearance of toxoplasma retinitis rather than a bacterial endophthalmitis (answer A). Surgical repair was deferred because of concern for active infectious retinitis (answer C). Given suspected infectious cardiomyopathy, serum toxoplasma IgG and IgM antibodies were drawn, infectious disease was consulted, and the patient started empirical treatement with oral trimethoprim-sulfamethoxazole. Systemic steroids (answer D) were deferred to avoid exacerbation of suspected disseminated toxoplasmosis.