A viral uveitis masquerade: PCR-confirmed Listeria monocytogenes necrotizing chorioretinitis complicated by secondary macular hole
Abstract
Background: Listeria monocytogenes is a rare ocular pathogen, and posterior segment infection is particularly uncommon. When it involves the retina, its presentation may overlap with viral hypertensive uveitis or necrotizing viral retinitis, especially in eyes with unilateral ocular hypertension, iris atrophy, and chronic recurrent inflammation. This diagnostic overlap may delay recognition of an unusual bacterial cause.
Findings: A 23-year-old male presented with progressive visual loss in the left eye after a five-year history of recurrent unilateral ocular redness and previously documented marked ocular hypertension. Examination revealed panuveitis with patchy iris stromal atrophy, pigment dispersion, vitreous inflammation, old peripapillary chorioretinal scars, and an active necrotizing chorioretinal lesion involving the macula, associated with retinal hemorrhage and a secondary macular hole. The initial impression was viral hypertensive uveitis with necrotizing chorioretinitis. Aqueous PCR for herpes simplex virus, varicella-zoster virus, and cytomegalovirus was negative, while bacterial multi-nested PCR detected L. monocytogenes. After oral and topical moxifloxacin were added to anti-inflammatory treatment, active intraocular inflammation had clinically resolved by 30 days, the necrotizing chorioretinal lesion evolved into an inactive scar, and the secondary macular hole progressively decreased in size before closing spontaneously. No systemic illness or…
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