Azathioprine/glucocorticoids/immune-globulin
- PDF / 174,677 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 6 Downloads / 125 Views
1 S
Toxoplasmosis chorioretinitis: 3 case reports In a case series, two women and one man aged 59–77 years were described, who developed toxoplasmosis chorioretinitis during treatment with prednisone, triamcinolone, azathioprine, immune-globulin or prednisolone acetate [not all dosages and routes stated; times to reaction onsets not stated]. This report describes a 59-year-old woman (Case 1), who had advanced glaucoma, underwent a bleb revision with bleb needling, and received mitomycin C and subtenons triamcinolone for a failed trabeculectomy in the left eye. Three days after the bleb revision, she experienced floaters, pain and acute loss of vision. She started receiving oral prednisone. One week later, she was referred for clinical evaluation. Her visual acuities were 20/25 in the right eye and hand motions in the left eye. She was observed with a relative afferent pupillary defect of the left eye. Slit lamp exam showed a triamcinolone depot in the inferior fornix and 2+ anterior chamber cell and vitreous cell in the left eye. Dilated examination of the left eye showed 2+ vitreous haze and patchy retinal whitening temporally in association with sclerotic-appearing vessels within the inferotemporal quadrant. She then received ceftazidime, vancomycin and foscarnet, and she was started on trimethoprim/sulfamethoxazole. Five days later, she developed a combined tractional and rhegmatogenous retinal detachment. She was thus hospitalised and underwent its repairement with pars plana vitrectomy, endolaser, silicone oil instillation, injection of vancomycin, voriconazole, ceftazidime and foscarnet, and excision of subtenons triamcinolone. Histopathologic analysis of vitreous specimens demonstrated bradyzoites consistent with toxoplasmosis. She was eventually diagnosed with toxoplasmosis chorioretinitis. Her therapy with trimethoprim/sulfamethoxazole was continued. At the final six-month follow-up, the toxoplasmosis chorioretinitis improved, but the visual acuity remained hand motions. This report describes a 77-year-old man (Case 2), who underwent pars plana vitrectomy, membrane peel and intravitreal triamcinolone for an epiretinal membrane in the left eye. Following surgery, he reported significant improvement in his distortion symptoms immediately. However, one month after the surgery, he complained of floaters and severe vision loss. He underwent eye examination, which revealed visual acuities of 20/20 in the right eye and counting fingers in the left eye. Slit lamp exam showed 2+ anterior chamber cell and trace anterior vitreous cell in the left eye. Funduscopic exam showed retinitis involving the posterior pole of the left eye. He started receiving valaciclovir due to an initial concern for herpetic acute retinal necrosis. He was then administered foscarnet, vancomycin and ceftazidime. PCR test was found positive for toxoplasmosis. Serologic testing revealed toxoplasmosis IgG positive at >250 IU/mL and toxoplasmosis IgM normal at
Data Loading...