Acquired Ocular Toxoplasmosis in a Dermatomyositis Patient with Immunosuppressant Therapy-A Case Report

一位以免疫抑制劑治療的皮肌炎患者之眼部弓漿原蟲感染－病例報告

陳葆如(Pao-Ju Chen) ； 周神彬(Shen-Pin Chou) ； 陳珊霓(San-Ni Chen)

《中華民國眼科醫學會雜誌》 49卷1期 (2010/03) Pp. 87-91

https://doi.org/10.30048/ACTASOS.201003.0013

摘要

目的：報告一位皮肌炎合併眼部弓漿原蟲感染的病例。
方法：病例報告。
結果：一位五十八歲的男性病人因左眼視力模糊約一個月前來求診。病人約兩年前診斷為皮肌炎，目前正持續接受口服免疫抑制劑治療。眼底檢查發現左眼在接近黃斑處有一個黃白色的病灶，約有十個視神經的大小，同時合併有二度玻璃體混濁。螢光血管攝影於晚期發現病灶邊緣有滲漏的現象。血清免疫學檢查顯示有弓漿原蟲的感染。我們持續給予抗弓漿原蟲藥物治療，但是病人於一個月後，嶺生左眼視網膜剝離合併玻璃體出血。在接受玻璃體切除，合併水晶體移除以及矽油灌注後，病人目前病情穩定，並已經停用抗原蟲藥物。

並列摘要

Purpose: To report a case of acquired ocular toxoplasmosis in a patient with dermatomyositis.
Method: case report.
Result: A 58-year-old male visited our clinic due to progressive blurred vision of the left eye for a month. He had a two-year history of dermatomyositis under immunosuppression therapy. There was a relative afferent papillary defect of the left eye. Ophthalmoscopic examination of the left eye showed a yellow-white retinochoroidal lesion located in the center of the macular region and a white retinochoroidal lesion measuring about 10 disc diameter with vitreous traction at the upper fundus with moderate vitreous opacity. Fluorescein angiography revealed leakage of the retinochoroidal lesion in the late phase. Both serum IgG and IgM showed positive reaction to toxoplasmosis. Antitoxoplasma therapy with oral sulfamethozazole trimethoprim (Baktar) was initiated and the vitreous opacity improved after two weeks. However, after one month of oral Baktar treatment, vitreous hemorrhage was noted and also retinal detachment was found when examining his fundus. The retina was reattached after vitrectomy, lensectomy and silicon oil infusion. His condition was stable thereafter and oral antibiotics were discontinued.
Conclusion: Clinical manifestations of ocular toxoplasmosis in immunosuppressed patients present different pictures as in immunocompetent patients. A more fulminant course seemed characteristic of immunosuppressed patients of ocular toxoplasmosis.

並列關鍵字

Dermatomyositis ； Ocular toxoplasmosis ； immunosuppression ； rhegmatogenous retinal detachment