Congenital toxoplasmosis must be differentiated from other possible causes of the classic clinical acronym 'TORCH' for a series of etiologies that share similar signs and symptoms. The acronym includes Toxoplasma, rubella, cytomegalovirus, syphilis, and herpes simplex virus. However, emerging pathogens such as West Nile Virus must be considered as part of any differential in known congenital infection (Alpert et al., 2003). Recurrent toxoplasmosis with its unilateral active lesion associated with multiple adjacent chori-oretinal scars with the appropriate clinical history is virtually pathognomonic. However, clinical syndromes such as serpiginous chorioretinitis, and other infectious etiologies such as cytomegalovirus, may occasionally be considered. For the many other possible and unusual manifestations of ocular toxoplasmosis, such as pars plani-tis, the differential diagnosis is even broader, and includes autoimmune disorders such as multiple sclerosis and infections such as Lyme disease. Importantly, there are likely many cases of unusual manifestations of ocular toxoplasmosis that remain undiagnosed because of the limits of non-invasive assays.
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