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Development of Bilateral Acquired Toxoplasmic Retinochoroiditis During Erlotinib Therapy

Veena Rao, MD, MSc1; Eric Schneider, MD1; Alan D. Proia, MD, PhD1,2; Sharon Fekrat, MD1
[+] Author Affiliations
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
2Department of Pathology, Duke University Medical Center, Durham, North Carolina
JAMA Ophthalmol. 2014;132(9):1150-1152. doi:10.1001/jamaophthalmol.2014.1088.
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Toxoplasma gondii retinochoroiditis is the most common cause of posterior uveitis in North America.1 Immunocompromised patients are particularly susceptible, and bilateral acquired toxoplasmic retinochoroiditis is thought to be rare without immunosuppression.1,2 We describe a woman who developed bilateral acquired toxoplasmic retinochoroiditis while undergoing treatment with erlotinib hydrochloride, an epidermal growth factor receptor tyrosine kinase inhibitor, in the absence of other immunomodulatory agents or neutropenia. When considered in conjunction with a recent report detailing similar findings in a patient treated with a related biologic therapeutic,3 the association of erlotinib with this unusual presentation suggests that inhibition of epidermal growth factor receptor and the downstream Janus kinase (JAK)–signal transducers and activators of transcription (STAT) pathway may be an underrecognized host risk factor for toxoplasmic retinochoroiditis.

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Figure 1.
Color Fundus Photographs of the Patient’s Right and Left Eyes

The right eye (right) showed vitritis obscuring the view of the optic nerve with several peripapillary areas of focal retinitis. Vitritis was also present in the left eye (left), with 1 area of focal retinitis temporal to the fovea.

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Figure 2.
Histopathologic Sections of the Patient’s Left Eye

A, Clinically noted lesions corresponded histologically to areas of retinochoroiditis with focal full-thickness retinal necrosis (hematoxylin-eosin, scale bar = 250 µm). B, One Toxoplasma gondii cyst containing tachyzoites was found (hematoxylin-eosin, scale bar = 25 µm).

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