Coinfection Suspicion is Imperative in Immunosuppressed Patients with Suspected Infectious Uveitis and Inadequate Treatment Response: A Case Report

Background: To report a case of coinfection of Toxoplasma gondii (Tg) and Epstein Barr Virus (EBV) in a diabetic patient with rheumatoid arthritis and immunosuppressive biological therapy. Case presentation: A 70-year-old female with a history of rheumatoid arthritis on therapy with corticosteroids, methotrexate, and abatacept presented bilateral granulomatous panuveitis associated with retinal necrosis and macular involvement. A diagnostic vitrectomy detected Tg and EBV. Treatment with clindamycin, trimethoprim-sulfamethoxazole, and acyclovir was established, achieving improvement. Conclusions: Patients undergoing immunosuppressive therapy are at risk of developing opportunistic infections, often presenting with severe and atypical clinical manifestations. In such cases, multiplex polymerase chain reaction is an invaluable diagnostic tool that helps identify the specific pathogens involved. This enables healthcare professionals to make informed treatment decisions and provide targeted therapy for each identified pathogen.