Our aim was to study optical coherence tomographic findings in a case of Toxocara granuloma. A patient with a cicatricial macular lesion, diagnosed as ocular toxocariasis, was examined with optical coherence tomography. In optical coherence tomography images, the macular granuloma appeared as a highly reflective round mass protruding above the retinal pigment epithelium with two other surrounding masses. Optical coherence tomography may increase understanding of the pathophysiology of the retinal Toxocara granuloma and help in the clinical diagnosis and management of its macular complications.Estudar os achados em tomografia de coerência óptica num caso de granuloma por Toxocara. Paciente com uma lesão macular cicatricial no olho esquerdo foi submetido a retinografia e tomografia de coerência óptica. Nas imagens de tomografia de coerência óptica, o granuloma aparece como uma imagem de uma massa arredondada hiper-reflectiva acima do epitélio pigmentar e abaixo da retina neurossensorial acompanhado de duas lesões satélites menores. A tomografia de coerência óptica pode nos ajudar a melhorar o entendimento da fisiopatologia do granuloma retiniano do Toxocara, seu diagnóstico e conduta.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Andrade, Rafael

Belfort, Rubens Junior

Lago, Aline do

Muccioli, Cristina

Arquivos Brasileiros de Oftalmologia

Our aim was to study optical coherence tomographic findings in a case of Toxocara granuloma. A patient with a cicatricial macular lesion, diagnosed as ocular toxocariasis, was examined with optical coherence tomography. In optical coherence tomography images, the macular granuloma appeared as a highly reflective round mass protruding above the retinal pigment epithelium with two other surrounding masses. Optical coherence tomography may increase understanding of the pathophysiology of the retinal Toxocara granuloma and help in the clinical diagnosis and management of its macular complications.Estudar os achados em tomografia de coerência óptica num caso de granuloma por Toxocara. Paciente com uma lesão macular cicatricial no olho esquerdo foi submetido a retinografia e tomografia de coerência óptica. Nas imagens de tomografia de coerência óptica, o granuloma aparece como uma imagem de uma massa arredondada hiper-reflectiva acima do epitélio pigmentar e abaixo da retina neurossensorial acompanhado de duas lesões satélites menores. A tomografia de coerência óptica pode nos ajudar a melhorar o entendimento da fisiopatologia do granuloma retiniano do Toxocara, seu diagnóstico e conduta.Universidade Federal de São Paulo (UNIFESP)UNIFESP, EPM, São Paulo, BrazilSciEL

Lago, Aline do [UNIFESP]

Andrade, Rafael [UNIFESP]

Muccioli, Cristina [UNIFESP]

Belfort, Rubens Junior [UNIFESP]

Repositório Institucional UNIFESP

Arq Bras Oftalmol. 2006;69(3):403-5Tomografia de coerência óptica em granuloma sub-retiniano por Toxocara:relato de casoVision Institute, Department of Ophthalmology, Fede-ral University of São Paulo – UNIFESP - Brazil.1 Medical Doctor (MD) at Universidade Federal de SãoPaulo - UNIFESP, São Paulo (SP) - Brasil.2 Medical Doctor (MD) at UNIFESP, São Paulo (SP) -Brasil.3 Medical Doctor (MD) at UNIFESP, São Paulo (SP) -Brasil.4 Medical Doctor (MD), PhD, at UNIFESP, São Paulo(SP) - Brasil.None of the authors has a proprietary interest in any ofthe products mentioned in this article.Addres to correspondence: Aline do Lago - Rua SenaMadureira, 1265, apt. 51, São Paulo (SP) - BrazilCEP 04021-051E-mail: alinelago@oftalmo.epm.brRecebido para publicação em 31.03.2005Versão revisada recebida em 02.11.2005Aprovação em 13.12.2005Nota Editorial: Depois de concluída a análise do artigosob sigilo editorial e com a anuência do Dr. Walter Yuki-hiko Takahashi sobre a divulgação de seu nome comorevisor, agradecemos sua participação neste processo.Aline do Lago1Rafael Andrade2Cristina Muccioli3Rubens Belfort Jr4Keywords: Granuloma/diagnosis; Retinal diseases; Eye infections, parasitic; Tomography,optical coherence/methods; Toxocara; Case reports [publication type]INTRODUCTIONVisceral larva migrans was first described by Beaver et al., to define a clinicalsyndrome of man characterized by hepatomegaly, fever, chronic eosinophiliaand hypergammaglobolulinemia(1). The common roundworms, Toxocara canisand Toxocara cati are still the most frequently incriminated agents.Transmission to human beings occurs by ingestion of contaminated soilor eggs on hands and fomites. Direct contact with infected dogs and catsplays a secondary role in transmission because eggs need an extrinsic periodto become infective. Neither worms nor eggs are eliminated in human fecesand because larvae are difficult to detect in tissues, diagnosis is mostly basedon serology(2).There are two forms of ocular Toxocara: visceral and ocular. Oculartoxocariasis is rare and therefore the spectrum of clinical disease is difficultto establish(3). Toxocara canis is a nematode infection with potentiallyserious consequences for vision(4), and is typically found in children belowthe age of sixteen(5).Wilkinson and Welch classificated ocular Toxocarainto: difuse endophtalmitis, posterior pole granuloma and peripheral(6).Probably the most common presentation is the granuloma found in theposterior pole or at the periphery(7). Standard diagnostic methods for ocularToxocara are fundoscopy, ultrasound and serologic tests. We studied thefeatures of a presumed subretinal Toxocara granuloma using optical cohe-rence tomography - OCT.CASE REPORTA 5-year-old boy with eye deviation for nine months was referred forexamination. Both physical examination and a complete blood cell countOptical coherence tomography in presumed subretinalToxocara granuloma: case reportOur aim was to study optical coherence tomographic findings in a caseof Toxocara granuloma. A patient with a cicatricial macular lesion,diagnosed as ocular toxocariasis, was examined with optical coherencetomography. In optical coherence tomography images, the maculargranuloma appeared as a highly reflective round mass protruding abovethe retinal pigment epithelium with two other surrounding masses.Optical coherence tomography may increase understanding of the patho-physiology of the retinal Toxocara granuloma and help in the clinicaldiagnosis and management of its macular complications.ABSTRACTRELATOS DE CASOS69(3)07.p65 12/6/2006, 16:18403Arq Bras Oftalmol. 2006;69(3):403-5404 Optical coherence tomography in presumed subretinal Toxocara granuloma: case reportwith differential count were normal. Visual acuity was 20/20 inthe right eye and counter fingers at 1m in the left eye and amedium angle endotropia was noticed. The anterior segmentwas quiet and the intraocular pressure was normal. An ill-defined whitish elevated lesion associated to smaller satellitelesions with a serous retinal detachment were observed in themacula of the left eye (Figure 1). No abnormalities were foundin the right eye.The patient's pupils were dilated with 0.5% cyclopentolateand 2.5% phenylephrine eye drops instilled at least 30 minutesbefore examination. Topical anesthetic eye drops (0.1% proxi-metain cloridate) were instilled immediately before examina-tion. After the examination, the patient was submitted to OCTevaluation. The fovea was measured four times for the 6 radialscans. Fundoscopy, classification and OCT were performedon the same day.Upon OCT examination, a central highly reflective subreti-nal round mass and another one smaller satellite mass structu-re, surrounded by subretinal fluid, were seen protruding abo-ve the retinal pigment epithelium in the macular area of the lefteye (Figure 1).A clinical diagnosis of ocular toxocariasis was made andconfirmed by the presence of circulating IgG antibodies by theenzyme-linked immunosorbent assay (ELISA).DISCUSSIONRecently it was demonstrated that the OCT is useful for thedifferential diagnosis between subretinal Toxocara granulo-ma and idiopathic choroidal neovascularization(8).The Toxocara larva is known to migrate across the retina,but the layer in which it migrates and its effect on the retinawas unknown(9). OCT images of our patient demonstrated thatthe presumed Toxocara granuloma had a subretinal extensionwith elevation and an ill-defined yellowish border associatedwith atypical smaller satellite lesions as well as serous retinaldetachment. The foveal involvement was clearly demonstra-ted by optical coherence tomography (Figure 2A). Cross-sectional optical coherence tomography images may increaseunderstanding of the pathophysiology of presumed subreti-nal Toxocara granulomas and help in the clinical managementof the retinal complications related to this disease.RESUMOEstudar os achados em tomografia de coerência óptica numcaso de granuloma por Toxocara. Paciente com uma lesãomacular cicatricial no olho esquerdo foi submetido a retinogra-fia e tomografia de coerência óptica. Nas imagens de tomogra-fia de coerência óptica, o granuloma aparece como uma ima-gem de uma massa arredondada hiper-reflectiva acima do epi-télio pigmentar e abaixo da retina neurossensorial acompanha-do de duas lesões satélites menores. A tomografia de coerên-cia óptica pode nos ajudar a melhorar o entendimento dafisiopatologia do granuloma retiniano do Toxocara, seu diag-nóstico e conduta.Descritores: Granuloma/diagnóstico; Doenças retinianas; In-fecções oculares parasitárias; Tomografia de coerência ópti-ca/métodos; Toxocara; Relatos de casos [tipo de publicação]REFERENCES1. Beaver PC, Snyder CH, Carrera GM, Dent JH, Lafferty JW. Chronic eosino-philia due to visceral larva migrans; report of three cases. Pediatrics. 1952;9(1):7-19.2. Nunes CM, Tundisi RN, Heinemann MB, Ogassawara S, Richtzenhain LJ.Toxocariasis: serological diagnosis by indirect antibody competition ELISA.Rev Inst Med Trop Sao Paulo. 1999;41(2):95-100.Figure 1 - Fundus photograph of the posterior pole of the left eye showsa large whitish elevated lesion (open arrow) with an ill-definedyellowish temporal border (arrowhead) associated with a smallersatellite lesion (arrow). Pigment hypertrophy and surrounding subre-tinal fluid were observed.Figure 2 - A: OCT scan reveals an elevated large subretinal lesion withserous retinal detachment associated with a smaller satellite lesion(arrow); B: OCT shows in a macular vertical scan a highly reflective sub-foveal spherical mass protruding above the retinal pigment epitheliumwith posterior shadow and surrounding subretinal fluid (open arrow).69(3)07.p65 12/6/2006, 16:18404Arq Bras Oftalmol. 2006;69(3):403-5Optical coherence tomography in presumed subretinal Toxocara granuloma: case report  4053. Gillespie SH, Dinning WJ, Voller A, Crowcroft NS. The spectrum of oculartoxocariasis. Eye. 1993;7( Pt 3):415-8. Comment in: Eye. 1993;7(Pt 6):810.4. Molk R. Ocular toxocariasis: a review of the literature. Ann Ophthalmol. 1983;15(3):216-9,222-7,230-1.5. Ashton N. Larval granulomatosis of the retina due to Toxocara. Br J Oph-thalmol. 1960;44:129-48.6. Wilkinson CP, Welch RB. Intraocular toxocara. Am J Ophthalmol. 1971;71(4):921-30.7. Rubin ML, Kaufman HE, Tierney JP, Lucas HC. An intraretinal nematode (acase report). Trans Am Acad Ophthalmol Otolaryngol. 1968;72(6):855-66.8. Higashide T, Akao N, Shirao E, Shirao Y. Optical coherence tomographicand angiographic findings of a case with subretinal Toxocara granuloma. AmJ Ophthalmol. 2003;136(1):188-90.9. Suzuki T, Joko, T, Akao N, Ohashi Y. Following the migration of a Toxocaralarva in the retina by optical coherence tomography and fluorescein angiogra-phy. Jpn J Ophthalmol. 2005;49(2):159-61.Jornada Internacional de Glaucomada Associação Paranaensede Oftalmologia*13 a 15 de Outubro de 2006Curitiba - PRINFORMAÇÕESTel.: (41) 3232-4031 • E-mail: drfcabibi@mps.com.br*Participação neste evento conta 5 pontos para a revalidação do título de especialista em oftalmologia69(3)07.p65 12/6/2006, 16:18405

Tomografia de coerência óptica em granuloma sub-retiniano por Toxocara: relato de caso

Estudar os achados em tomografia de coerência óptica num caso de granuloma por Toxocara. Paciente com uma lesão macular cicatricial no olho esquerdo foi submetido a retinografia e tomografia de coerência óptica. Nas imagens de tomografia de coerência óptica, o granuloma aparece como uma imagem de uma massa arredondada hiper-reflectiva acima do epitélio pigmentar e abaixo da retina neurossensorial acompanhado de duas lesões satélites menores. A tomografia de coerência óptica pode nos ajudar a melhorar o entendimento da fisiopatologia do granuloma retiniano do Toxocara, seu diagnóstico e conduta.Our aim was to study optical coherence tomographic findings in a case of Toxocara granuloma. A patient with a cicatricial macular lesion, diagnosed as ocular toxocariasis, was examined with optical coherence tomography. In optical coherence tomography images, the macular granuloma appeared as a highly reflective round mass protruding above the retinal pigment epithelium with two other surrounding masses. Optical coherence tomography may increase understanding of the pathophysiology of the retinal Toxocara granuloma and help in the clinical diagnosis and management of its macular complications.Universidade Federal de São Paulo (UNIFESP)UNIFESP, EPM, São Paulo, BrazilSciEL

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Tomografia de coerência óptica em granuloma sub-retiniano por Toxocara: relato de caso

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