Cytomegalovirus Retinitis in a Patient with Idiopathic Thrombocytopenic Purpura on Oral Prednisolone Treatment: A Case Report

罹患原發性血小板缺乏紫斑症經口服類固醇治療之患者併發巨細胞病毒視網膜炎：病例報告

林意純(Yih-Chun Lin) ； 何明山(Ming-Shan He) ； 蔡榮坤(Rong-Kung Tsai)

《中華民國眼科醫學會雜誌》 49卷1期 (2010/03) Pp. 36-41

https://doi.org/10.30048/ACTASOS.201003.0005

摘要

目的：報告一名罹患原發性血小板缺乏紫斑症經口服類固醇治療之患者，併發非典型表現的巨細胞病毒視網膜炎，藉由抽吸前房水而診斷巨細胞病毒，並成功治療的病例。
方法：病例報告
結果：一名55歲原本患有糖尿病與高血壓的女性，於2008年二月診斷出原發性血小板缺乏紫斑症，接受口服類固醇治療。在同年四月底因肺囊蟲肺炎合併呼吸衰竭而入院接受插管、呼吸器治療，其血清HIV Ab為陰性。出院後一週出現左眼紅症狀而到門診求診。眼科檢查發現玻璃體混濁、鼻側全層視網膜浸潤、小動脈閉鎖、局部視網膜出血，初步診斷為急性視網膨壤死，經Acyclovir治療後，僅玻璃體炎逐漸改善。藉由前房抽吸房水呈送病毒聚合酵素鏈鎖反應而診斷巨細胞病毒感染。在確定診斷巨細胞病毒視網膜炎後，將藥物改為Gancyclovir靜脈注射治療，打滿Gancyclovir兩週的療程後改為口服藥出院，一個月後眼部病灶幾近完全消失且視力恢復正常。
結論：原發性血小板缺乏紫斑症，經口服類固醇治療的患者，因免疫力不全而伺機感染巨細胞病毒視網膜炎可說少見。非典型表現的巨細胞病毒視網膜炎可藉由房水的病毒聚合酵素鏈鎖反應而確定診斷。

並列摘要

Purpose: To present one case of cytomegalovirus (CMV) retinitis in an idiopathic thrombocytopenic purpura patient on oral prednisolone therapy.
Methods: A case report. Results: A 55-year-old female patient was treated with oral Prednisolone for idiopathic thrombocytopenic purpura (ITP) for 6 months. She suffered from pneumocystic carinii pneumonia, which eventually resulted in respiratory failure and the patient received endotracheal tube intubation in April 2008. Serum HIV was negative. One month later, she presented with redness in her left eye. Fundus examinations suggested acute retinal necrosis, and she was placed on intravenous Acyclovir therapy. Aspiration of the aqueous from the anterior chamber demonstrated a positive reaction to CMV DNA by using polymerase chain reaction (PCR). The medication was switched to intravenous Ganciclovir therapy. Vitritis, cotton wool spots, and granular retinitis were improved after Ganciclovir therapy. The patient's visual function recovered completely one month later.
Conclusions: Cytomegalovirus retinitis rarely occurs in patients with ITP and under steroid treatment. Aqueous aspiration for virus DNA detection by PCR is recommended to confirm the diagnosis.

並列關鍵字

Cytomegalovirus retinitis ； Ganciclovir ； idiopathic thrombocytopenic Purpura