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以雙眼弓漿蟲視網膜眼炎為起始表現的後天免疫缺乏症候群－病例報告
Bilateral Ocular Toxoplasmosis as Initial Presentation of Aids-A Case Report
摘要
目的：發表一個少見以雙眼弓漿蟲視網膜眼炎為起始表現的後天免疫症候群病例。 報告方法：病例報告。 結果：這位33歲男性因為左眼視力模糊約一個月，至眼科求診。當時左眼最佳矯正視力為2/60，而右眼為6/6；雙眼眼壓及外眼部、結膜、角膜、前房、瞳孔反射以及水晶體均正常。眼底檢查發現兩眼都呈現局部視網膜炎。而血清免疫檢查結果發現梅毒血清反應(Venereal Disease Research Laboratories, VDRL)及梅毒螺旋體血液凝集檢查(Treponema Pallidum Hemagglutination, TPHA)以及愛滋病病毒抗體篩檢(Human ImmunodeficiencyVirus antigen body, HIVAb)檢驗皆呈現陽性，淋巴球T輔助細胞CD4白血球數量為24/立方公釐，且弓漿蟲IgG抗體(Toxoplasma-IgG)以及弓漿蟲IgM抗體(Toxoplasma-IgM)都是陽性反應。診斷為後天免疫症候群(Acquired immunodeficiency syndrome, AIDS)合併雙眼弓漿蟲視網膜眼炎。在接受了高活性抗反轉錄病毒治療法(highly active antiretroviral therapies, HARRT)及6個星期的pyrimethamine、clindamycin合併治療弓漿蟲感染後，雙眼視網膜的病灶已緩解，左眼最佳矯正視力也回到6/6。 結論：弓漿蟲視網膜眼炎在愛滋病患的眼球感染中很少見，只佔了約1~3%，及時診斷及早期使用抗病毒和抗弓漿蟲藥物治療可以避免進一步的擴散及組織破壞，並保存視力。
關鍵字
無資料並列摘要
Purpose: To present an uncommon case of ocular toxoplasmosis with AIDS. Methods: Case report. Result: This 33-year-old male complained of blurred vision over his left eye for about one month. His best-corrected visual acuity was 2/60 in the left eye, and 6/6 in the right eye. Intraocular pressure was within normal range and the anterior segment was quiet. Fundus examination revealed a bilateral focal retinitis patch. Immune studies revealed no remarkable findings. Serology revealed a positive VDRL and HIV test. The CD4 count was 24 / mm3. He was subsequently found to be Toxoplasma-IgM positive. He then received highly active antiretroviral therapies (HARRT) and pyrimethamine- clindamycin combination treatment for ocular toxoplasmosis for 6 weeks. The retinal lesions gradually subsided. His best-corrected visual acuity recovered to 6/6 in both eyes. Conclusion: Ocular toxoplasmosis is uncommon and accounts for 1~3% of ocular infection in patients with AIDS. Prompt recognition and early treatment with both anti-viral and anti-toxoplasmosis drug therapy will prevent widespread tissue destruction, preserve vision and reduce dissemination.