నైరూప్య

A rare case of third nerve palsy in acquired immune deficiency syndrome

Harshini Rajula, Nanda L, Kaushal Kumar, Nidhi Chandrakar, Anil Kumar Shukla

A male aged 40 years was presented with double vision and blurring of vision persisting for past one week. He is known case of Hospital where he was admitted and treated for tuberculosis. He was detected retro-positive six months earlier was not on anti-retroviral therapy. His BCVA was 6/9(p) in both eyes. Left eyelid was with partial ptosis present and pupil was mid dilated, non-reacting to light. It was also noticed restriction of adduction, elevation and depression in left eye. Right eye EOM was full and normal. Vertical crossed diplopia was present. Fundus examination revealed tessellated background in both eyes. MRI (contrast) revealed inflammatory etiology to be considered as Toxoplasmosis. It was estimated that Neuro-Ophthalmic manifestations occur in 2%-8% of Human Immune Deficiency Virus (HIV) infected patients. Toxoplasmosis could be a cause of third nerve palsy in HIV infected patient.