Pyrimethamine Treatment for Toxoplasmosis Uveitis in An AIDS Patient

使用Pyrimethamine成功治療愛滋病患相關之弓漿蟲葡萄膜炎

陳怡伶(Yi-Ling Che) ； 張心怡(Hsin-Yi Chang) ； 彭繼賢(Chi-Hsien Peng)

《輔仁醫學期刊》 17卷3期 (2019/09) Pp. 141-145

https://doi.org/10.3966/181020932019091703005

摘要

Objective: To report the effect of pyrimethamine treatment in ocular toxoplasmosis which failed to treat with baktar and clindamycin in a 43-year-old male with acquired immune deficiency syndrome (AIDS). Methods: Retrospective interventional case report. Results: This case presented with left blurred vision, and left fundoscopy revealed necrotizing retinitis, frosted angitis and kyrielesis plaques. These findings were characterized with toxoplasmosis uveitis with elevated aqueous toxoplasmosis IgG level. He was undergoing HARRT, anti-tuberculosis therapy combined with trimethoprim-sulfamethoxazole (baktar) and clindamycin for systemic opportunistic infection, but toxoplasmosis uveitis still occurred. We started full pyrimethamine therapy for 28 days and the retinitis resolved gradually without recurrence at 14 months follow-up. Conclusions: Pyrimethamine treatment rather than baktar and clindamycin therapy is effective for AIDS-related toxoplasmosis uveitis.

關鍵字

Pyrimethamine ； Toxoplasmosis ； AIDS

並列摘要

目的：報告使用Pyrimethamine成功治療43歲愛滋男性病患相關之baktar／clindamycin治療無效的弓漿蟲葡萄膜炎。方法：回顧性介入病例報告。結果：此愛滋病患抱怨左眼模糊，左眼眼底呈現糜爛性視網膜炎、冰凍狀血管炎和動脈旁斑塊。此症狀合併房水內升高的弓漿蟲指數是典型的弓漿蟲葡萄膜炎。病患開始雞尾酒療法、抗結核菌治療並使用baktar／clindamycin治療全身伺機性感染，但是弓漿蟲葡萄膜炎仍然產生。我們使用Pyrimethamine完整28天治療，病患視網膜炎逐漸好轉，14個月後追蹤視力穩定沒有復發。結論：於愛滋病患罹患弓漿蟲葡萄膜炎，相較於baktar／clindamycin的治療，Pyrimethamine完整治療才能有效治癒。

並列關鍵字

弓漿蟲葡萄膜炎 ； 愛滋病患 ； Pyrimethamine