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Acute Acquired Ocular Toxoplasmosis-A Case Report
急性後天性眼弓漿蟲症－病例報告
摘要
本文報告一例58歲健康男性左眼突然發生視力模糊及飛蚊症狀約六天，視力為辨指數，眼底檢查發現視網膜黃斑部有一圓形黃白色炎性壞死病變，大小約一個視神經盤，伴隨著玻璃體及前房炎性反應。因其嚴重之玻璃體混濁，導致其壞死區域看起來像是“霧中頭燈”的現象，病患血清及前房水中測得抗弓漿蟲之抗體IgG及IgM，經由計算Goldmann-Witmer coefficient（房水中抗弓漿蟲之IgG/血清中抗弓漿蟲之IgG：房水中全部IgG/血清中全部IgG）^1，得到結果為2.27（大於l），代表眼內確實受到感染，診斷為急性後天性眼弓漿蟲症，在使用sulfamethoxazole/trimethoprime (baktar)，clindamycin，prednisolone治療後，視網膜之炎性壞死病變逐漸消退，藥物治療十週後，炎性壞死病變區可見一萎縮斑痕，最佳矯正視力進步至零點壹，追蹤至今八個月並無復發現象。 在臺灣，後天性眼弓漿蟲症相當罕見，經由計算Goldmann-Witmer coefficient來診斷眼內弓漿蟲感染是有效且專一性高的方法。
關鍵字
無資料並列摘要
We presented a 58-year-old healthy male who suffered from sudden onset of blurred vision and floaters in his left eye for 6 days. In our clinic, the visual acuity of his left eye was counting finger and a solitary, yellowish white retinal necrotic lesion about one disc diameter with vitritis and anterior uveitis was noted on ocular examination. The retinal necrotic lesion was on the macula, and looked like ”headlight in the fog” due to heavy vitreous reaction. Positive results of anti-toxoplasma IgG and IgM in serum and aqueous were found. The Goldmann-Witmer coefficient (toxoplasma IgG in aqueous/toxoplasma IgG in serum: total IgG in aqueous/total IgG in serum)1 was greater than 1 (2.27), suggesting an intraocular infection. Acute acquired ocular toxoplasmosis was diagnosed, and he was treated with sulfamethoxazole/trimethoprime (baktar), clindamycin and prednisolone. The retinal necrotic lesion gradually resolved. After treatment for 10 weeks, the chorioretinitis lesion left an atrophic scar and best corrected visual acuity (BCVA) improved to 6/60. No recurrent lesion was noted during the 8-month follow-up period. Acquired ocular toxoplasmosis is seldom seen in Taiwan. Goldmann-Witmer coefficient may be an effective and specific method for the diagnosis of intraocular toxoplasmosis infection.
延伸閱讀
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