眼内注射甲氨蝶呤治疗难治性结核性匐行性脉络膜视网膜炎。
TREATMENT OF REFRACTORY TUBERCULAR SERPIGINOUS-LIKE CHOROIDITIS WITH INTRAVITREAL METHOTREXATE.
机构信息
Department of Ophthalmology, New York University School of Medicine, New York, New York.
Northern Westchester Hospital Center, Mt. Kisco, New York.
出版信息
Retin Cases Brief Rep. 2021 Mar 1;15(2):169-173. doi: 10.1097/ICB.0000000000000767.
PURPOSE
To describe a case of tubercular serpiginous-like choroiditis that progressed, despite antitubercular medication, corticosteroids, and immunomodulatory treatment, which ultimately quieted after two intravitreal methotrexate injections.
METHODS
Case report.
RESULTS
A 35-year-old woman reported a shadow in the left eye for 2 weeks. She presented with tubercular serpiginous-like choroiditis in the right eye 2 years prior. At that time, she was started on antituberculosis therapy but was noncompliant and lost to follow-up. On re-presentation, there was a new active left-eye serpiginous lesion, with repeat positive QuantiFERON gold testing. Four antituberculosis drugs were started, followed by corticosteroids and azathioprine, with continued progression despite aggressive treatment. She was finally given 2 intravitreal methotrexate injections (400 μg/0.1 cc) 1 month apart, with final arrest of lesion extension. The uveitis remained quiet for over 24 months, and the patient was able to discontinue all systemic therapy.
CONCLUSION
Intravitreal methotrexate injections halted progression of treatment-refractory tubercular serpiginous-like choroiditis.
目的
描述一例结核匐行性脉络膜炎病例，尽管进行了抗结核药物、皮质类固醇和免疫调节治疗，但病情仍在进展，最终在两次玻璃体内甲氨蝶呤注射后得到缓解。
方法
病例报告。
结果
一名 35 岁女性因左眼出现阴影 2 周就诊。2 年前右眼曾出现结核匐行性脉络膜炎，当时开始进行抗结核治疗，但患者不遵医嘱且失访。此次就诊时，左眼出现新的活动性匐行性病变，重复的 QuantiFERON gold 检测结果呈阳性。给予 4 种抗结核药物治疗，随后加用皮质类固醇和硫唑嘌呤，但尽管进行了强化治疗，病情仍在进展。最终，患者接受了 2 次玻璃体内甲氨蝶呤注射（400μg/0.1cc），间隔 1 个月，病变扩展最终停止。葡萄膜炎在 24 个月以上保持稳定，患者得以停用所有全身治疗。
结论
玻璃体内甲氨蝶呤注射阻止了治疗抵抗性结核匐行性脉络膜炎的进展。
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