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早期復發之後天性眼部弓漿蟲病－病例報告
Acquired Ocular Toxoplasmosis with Early Recurrence-A Case Report
摘要
弓漿蟲侵犯人體眼部可造成嚴重的視力受損，大部分皆為先天性復發病灶，後天性眼部弓漿蟲病則較為少見，故提出我們的治療經驗。－35歲男性，右眼視力模糊，眼壓升高，虹膜睫狀體發炎。眼底檢查發現－壞死性視網膜脈絡膜病灶，其上有嚴重之玻璃體發炎。血清學檢查證實抗弓漿蟲抗體呈陽性。病人一度在他處因局部類固醇注射致病灶擴大，經給予六週之口服Co-trimoxazole及Prednisolone後，發炎混濁消失。後因有復發的現象而再給予一次療程，病人最後留下右眼眼底一萎縮性瘢痕組織。本病例並無先天性眼部弓漿蟲病常見的視網膜色素沉著萎縮性瘢痕組織及其周圍的衛星狀再發病灶之表現，為一後天性眼部弓漿蟲病。眼球周圍局部類固醇注射對於後天性眼部弓漿蟲病，同樣會導致嚴重惡化。CO-trimoxzazole對於此類後天性病灶有療效，但對預防早期再發似無效果，故病人仍須接受長期的追蹤檢查。
關鍵字
無資料並列摘要
Congenital toxoplasmosis is a rather frequent cause of posterior uveitis, while acquired lesion is relatively uncommon in adults. A 35 year-old male was referred to our clinic due to blurred vision (OD) for one week and failure of treatment with periocular steroid injection. No history of immuno-compromise was noted. The best corrected vision acuity (VA) decreased to 20/400 and IOP elevated to 30 mmHg in the right eye. Anterior chamber and vitreous showed 2+ cells. Fundus examination revealed a yellowish retinal lesion over papillomacular bundle with overlying vitritis (OD). No satellite lesion or existing retinal scar was noted at that time. The clinical signs and the serologic tests indicated toxoplasma infection. After the treatment of oral co-trimoxazole (trimethoprim-sulfamethoxazole) and corticosteroid for 6 weeks, the necrotic retinochoroiditis became quiet and decreased in size, VA improved to 10/100 (OD). However, the lesion size enlarged and vitritis flared up again 2 weeks later, so another course of treatment was initiated. His VA improved to 20/100(OD), although a paracentral scotoma was left. Periocular steroid injection should be avoided in ocular toxoplasmosis. Co-trimoxazole is effective in acquired ocular toxoplasmosis, but long-term following up is needed due to possible early recurrence.