Multi-omics-guided diagnosis and treatment of toxoplasma retinochoroiditis with co-infection: a case report.

BACKGROUND: Toxoplasma retinochoroiditis is challenging to diagnose and treat, especially in immunocompromised or co-infected individuals. This report describes a complex vision loss case in a syphilis and tuberculosis-history patient, demonstrating the utility of multi-omics in guiding diagnosis and treatment. A 50-year-old female with treated syphilis and tuberculosis had right eye floaters and visual disturbances, with panuveitis and retinal lesions on exam. Aqueous humor multi-omics confirmed Toxoplasma gondii (no syphilis or tuberculosis DNA), and she recovered with 8-week trimethoprim-sulfamethoxazole plus tapered prednisone (initiated 72h post-antimicrobial therapy).

CONCLUSION: This case highlights the diagnostic challenges of ocular inflammation in patients with co-infections and demonstrates the value of multi-omics-guided intraocular fluid analysis for precise pathogen identification. This case supports a combined treatment strategy of anti-toxoplasmosis medication and cautious corticosteroid use, which-despite the risk of reactivating latent infections-can achieve excellent anatomical and visual outcomes.