Lv Xiaoli, Yu Pingping
Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Medicine (Baltimore). 2018 Jun;97(26):e11231. doi: 10.1097/MD.0000000000011231.
Toxoplasma gondii is distributed worldwide, infecting a large population. It can cause focal necrotic retinitis or retinochoroiditis in the human eyes and is one of the most common causes of posterior uveitis.
A 68-year-old patient with normal immunity was complained about blurred vision and black shadow in the right eye for 1 week.
Combined Yellow-and-white bulged lesions in the fundus of the right eye with the Goldmann-Witmer coefficient = 2 and based on the serological indicators, we considered the diagnosis of T. gondii infection-induced retinochondritis.
Acetylspiramycin 0.4 QID × 3 weeks, concussive 20 days treatment after 3 days, for a total of 3 months, prednisone 20 mg/day with a weekly reduction of 5 mg for 1 month.
After oral acetylspiramycin, topical and systemic corticosteroids for 3 months, the retinal lesions were scarred, and inflammation of the anterior chamber and vitreum disappeared. After a 9-month follow-up, the visual acuity was 0.6, and no active lesions were observed in the fundus.
The immunocompetent elderly who are in contact with domestic cats may have an opportunistic infection with toxoplasmosis leading to primary retinochoroiditis. Prompt diagnosis and effective treatment can get a good clinical prognosis.
刚地弓形虫在全球范围内分布，感染大量人群。它可导致人类眼部出现局灶性坏死性视网膜炎或视网膜脉络膜炎，是后部葡萄膜炎最常见的病因之一。
一名68岁免疫功能正常的患者因右眼视物模糊和黑影1周前来就诊。
右眼眼底可见黄白色隆起病变，Goldmann-Witmer系数 = 2，结合血清学指标，考虑诊断为弓形虫感染所致视网膜脉络膜炎。
乙酰螺旋霉素0.4克，每日4次，共3周，3天后冲击治疗20天，共3个月，泼尼松20毫克/天，每周减量5毫克，共1个月。
口服乙酰螺旋霉素、局部及全身应用糖皮质激素3个月后，视网膜病变形成瘢痕，前房及玻璃体炎症消失。随访9个月后，视力为0.6，眼底未见活动性病变。
接触家猫的免疫功能正常的老年人可能会发生弓形虫机会性感染，导致原发性视网膜脉络膜炎。及时诊断和有效治疗可获得良好的临床预后。
