[Atypical ocular toxocariasis in a child: A case report]. / Toxocarose oculaire atypique chez un enfant : à propos d'un cas.

INTRODUCTION: Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment. OBSERVATION: A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved. DISCUSSION: Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis. CONCLUSION: Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.

[Ethambutol-induced toxic optic neuropathy during treatment of tuberculosis meningitis in a child]. / Neuropathie optique toxique à l'éthambutol au cours d'une méningite tuberculeuse chez un enfant.

INTRODUCTION: Toxic optic neuropathy is a severe optic nerve injury that can compromise the prognosis for vision, justifying early clinical and ancillary diagnosis. CASE DESCRIPTION: We report the case of an 11-year-old child being treated for tuberculous meningitis with a combination of ethambutol and three other anti-bacillary drugs, referred for a rapidly progressive bilateral decline in visual acuity. On ophthalmologic examination, the visual acuity was counting fingers within 1ft in both eyes, and bilateral optic disc pallor was noted, without other associated abnormalities. Neurological imaging was unremarkable, with red-green dyschromatopsia and a bilateral cecocentral scotoma. Faced with this clinical and paraclinical picture, we arrived at the diagnosis of ethambutol toxic optic neuropathy, with a multidisciplinary decision leading to a change in the antibacillary treatment protocol. No clinical improvement was noted after 3 months of follow-up. DISCUSSION: Optic nerve toxicity is rare in children and is classically described as dose- and time-dependent. CONCLUSION: Ethambutol ocular toxicity is extremely rare in children, and the required action when detected is to discontinue the drug. Reversibility is not always assured, which requires early detection of toxic optic neuropathy by close clinical and ancillary monitoring and, above all, sensitization of the treating physicians (pediatricians, pulmonologists and neurologists).