暴发性眼弓形体病：皮质类固醇单药治疗的危害。
Fulminant Ocular Toxoplasmosis: The Hazards of Corticosteroid Monotherapy.
机构信息
a Department of Ophthalmology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
b Ulucanlar Eye Education and Training Hospital Ophthalmology Clinic , Ankara , Turkey.
出版信息
Ocul Immunol Inflamm. 2016 Dec;24(6):637-646. doi: 10.3109/09273948.2015.1057599. Epub 2015 Dec 8.
PURPOSE
To describe fulminant toxoplasma retinochoroiditis induced by corticosteroid monotherapy.
METHODS
Clinical records of nine patients were reviewed.
RESULTS
All patients (five female, four male; aged 15-64 years) had been misdiagnosed as unilateral non-infectious uveitis and given systemic and/or local corticosteroid injections elsewhere. Mean disease duration before referral was 105.6 ± 71 (45-240) days. Visual acuity at presentation was <20/200 in six eyes. Average lesion size was 6.6 disc areas in eight eyes and all four quadrants were involved in one. Toxoplasma DNA was detected in eight tested eyes. Mean duration of anti-toxoplasmic therapy was 92.5 ± 37.1 days. Three eyes developed rhegmatogenous retinal detachment. Four patients underwent pars plana vitrectomy. Final visual acuity was <20/200 in five eyes.
CONCLUSIONS
Iatrogenic immunosuppression due to initial misdiagnosis may lead to an aggressive course and serious complications of ocular toxoplasmosis, a potentially self-limiting infection.
目的
描述由皮质类固醇单药治疗引起的暴发性弓形体视网膜脉络膜炎。
方法
回顾了 9 名患者的临床记录。
结果
所有患者（5 名女性，4 名男性；年龄 15-64 岁）均被误诊为单侧非感染性葡萄膜炎，并在其他地方接受了全身和/或局部皮质类固醇注射。转诊前的平均疾病持续时间为 105.6±71（45-240）天。6 只眼的视力在就诊时<20/200。8 只眼中的平均病变大小为 6.6 个视盘面积，所有 4 个象限均受累 1 个。在 8 只受检眼中检测到弓形虫 DNA。抗弓形虫治疗的平均持续时间为 92.5±37.1 天。3 只眼发生孔源性视网膜脱离。4 名患者接受了玻璃体切除术。5 只眼的最终视力<20/200。
结论
由于最初的误诊导致的医源性免疫抑制可能导致眼弓形体病的侵袭性病程和严重并发症，而眼弓形体病是一种潜在的自限性感染。
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