Unilateral Acute Macular Toxoplasmic Chorioretinitis Associated with White Dot-Like Choroidal Involvement Demonstrated on Indocyanine Green Angiography

A 9-year-old otherwise healthy boy was examined due to a 4-day history of visual decline in his right eye. Ophthalmological examination revealed an area of active retinochoroiditis in the right macula. Indocyanine green angiography (ICGA) demonstrated multiple hypocyanescent dots surrounding the active lesion extending 360 degrees towards the equator. Optical coherence tomography angiography (OCTA) exhibited dark dots on the choriocapillaris slab over areas corresponding to the hypocyanescent dots detected with ICGA. Full systemic examination and laboratory investigations were carried out. Toxoplasma gondii serology was positive. The diagnosis of toxoplasmic chorioretinitis with white dot-like choroidal involvement was made. Trimethoprim/sulfamethoxazole, azithromycin, and oral prednisolone were administered orally. On repeated ICGA 2 weeks later, the scattered hypocyanescent dots were significantly fewer in number. A month later, right visual acuity was improved, the macular chorioretinitis focus had become inactive, an epiretinal membrane had formed, and the dark dots on the choriocapillaris slab of OCTA were markedly diminished. ICGA may be helpful to observe possible, subtle choroidal involvement in patients with toxoplasmic chorioretinitis.