Cotrimoxazole
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Myopic shift: case report A 20-year-old woman developed myopic shift during treatment with cotrimoxazole for septicaemia. The woman, who had been diagnosed with septicaemia treated with oral cotrimoxazole [Bactrim; sulfamethoxazole/ trimethoprim] 800/160mg for 7 days. She presented with bilateral blindness following woke up; however, on the previous day, her visual acuity was normal. She did not have a history of fluctuation in vision. She had malaise, moderate to severe headaches, fever and abdominal pain for approximately 3 weeks. Blood culture performed at her primary care physician showed Escherichia coli and Staphylococcus aureus infection. Her primary care physician suggested to continue oral cotrimoxazole treatment. She also reported that she had recently married and travelled to Colorado and New Mexico. Following 5-6 weeks after returned to the home, she started experiencing above symptoms. On anamnesis it was noted that she had a history of mild fever, migraine headaches, fatigue, joint pain and occasional skin rashes, which were significant with undiagnosed systemic lupus erythematosus. Best-corrected manifest refraction showed high myopia (right eye:–6.00 –0.75 009, 20/25-2; left eye: -6.50 -0.75 162, 20/25-2). Her pupils were equal, round and reactive to light without any signs of afferent pupil defect in either eye. Extraocular motility and alignment were found to be normal without pain in both eyes. Standard automated static perimetry was precise with only one fixation loss without false-positive or false-negative errors on initial and subsequent testing in either eye. Initial testing showed remarkable bilateral depression worst in the right eye. Her colour vision was found to be normal (Ishihara test: right eye, 13/14 plates; left eye, 13/14 plates). Anterior segment examination was unremarkable with the exception of mild ptosis in the left eye, mild blepharitis and dry eye syndrome with narrow angles. Au-Henkind test was negative, and there no notable cells or flare. Intraocular pressure was normal. The woman was treated with tropicamide, which resulted in cycloplegia that regressed myopia and somewhat opening of anterior chamber angles. The posterior pole examination showed macular folding, macular oedema and venous stasis with few scattered microaneurysms and small intraretinal haemorrhages in both eyes. Optic coherence tomography showed normal foveal contours with mild inferior nasal thickening of the retina in both eyes. Symmetrical optic nerves were noted with distinct margins lacking pallor and with cup-to-disc ratios of 0.15 in both eyes. She reported that she discontinued cotrimoxazole, which was prescribed by her primary care physician on the day of initial examination. She was informed about symptoms of acute angle closure glaucoma and explained that extreme myopic shift was possibly related to underlying infectious disease, inflammatory disease, medication or less likely with hyperglycaemia. She was under careful observation for few days. Random glucose level was 83 mg/dL. On the nex
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