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A 40 year old south Asian male is presented with double vision and blurring of vision since one week. He is known case of tuberculosis, admitted and completed treatment and was detected retro positive 2 years before. Patient was not on ART. His BCVA was 6/9(p) in both eyes. Left eyelid partial ptosis is present. Pupil is mid dilated and non-reacting to light. Right eye pupil was sluggishly reacting to light. Restriction of adduction, elevation and depression in left eye was noticed. Right eye EOM was full and normal. Diplopia charting showed vertical crossed diplopia. Fundus examination revealed chorioretinal atrophic patch in left eye and right eye was normal. MRI (contrast) revealed HIV encephalopathy and inflammatory etiology to be considered as Toxoplasmosis. Neuroophthalmic manifestations have been estimated to occur in 2-8% of HIV infected patients. Toxoplasmosis can be a cause of third nerve palsy in HIV infected patient. Early treatment can prevent the further progression of the disease.
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