Santín M, Podzamczer D, Bolao F, Prat J, Rufí G, Ariza J, Lillo J
Departamento de Medicina, Hospital de Bellvitge-Prínceps d'Espanya.
Med Clin (Barc). 1990 Mar 24;94(11):423-5.
Ocular toxoplasmosis is an uncommonly reported complication in patients with acquired immunodeficiency syndrome. Three patients with human immunodeficiency virus (HIV) infection and ocular toxoplasmosis are reported. In two of them, cerebral toxoplasmosis was associated. Ocular involvement presented as exudative chorioretinitis, bilateral in 2 cases and unilateral in 1. The diagnosis was made on the basis of ocular disease associated with lesions consistent with toxoplasmosis of central nervous system (CNS) and response to antitoxoplasma treatment in one case, and ocular disease with rising antitoxoplasma serologic titers in the remaining two. Initial therapy included pyrimethamine plus sulfadiazine in 2 cases and pyrimethamine plus clindamycin in 1. The 2 patients treated with sulfadiazine showed hypersensitivity features, and clindamycin had to be substituted. The response to therapy was favorable, although one patient died few days after the development of CNS lesions. When chorioretinitis develops in a patient with HIV infection, ocular toxoplasmosis should be considered. As CNS involvement is commonly associated and relapse after the withdrawal of therapy is likely, these patients should be treated as those with isolated toxoplasma encephalitis.
眼部弓形虫病是获得性免疫缺陷综合征患者中报道较少的一种并发症。本文报告了3例人类免疫缺陷病毒（HIV）感染合并眼部弓形虫病的患者。其中2例合并脑弓形虫病。眼部病变表现为渗出性脉络膜视网膜炎，2例为双侧，1例为单侧。1例患者根据眼部疾病合并与中枢神经系统（CNS）弓形虫病相符的病变以及对抗弓形虫治疗的反应做出诊断，其余2例根据眼部疾病伴抗弓形虫血清学滴度升高做出诊断。初始治疗包括2例使用乙胺嘧啶加磺胺嘧啶，1例使用乙胺嘧啶加克林霉素。2例接受磺胺嘧啶治疗的患者出现过敏反应，不得不改用克林霉素。尽管1例患者在CNS病变出现几天后死亡，但治疗反应良好。当HIV感染患者发生脉络膜视网膜炎时，应考虑眼部弓形虫病。由于CNS受累常见且停药后可能复发，这些患者应按孤立性弓形虫脑炎患者进行治疗。
