Mushtaq Faiza, Ahmad Amna, Qambar Fizza, Ahmad Aysha, Zehra Naveen
Ophthalmology, Dow University of Health Sciences, Karachi, PAK.
Internal Medicine, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2019 Feb 4;11(2):e4001. doi: 10.7759/cureus.4001.
Ocular toxoplasmosis occurs subsequently after systemic infection with the protozoan parasite, Toxoplasma gondii (T. gondii). The parasite has a high affinity for retinal microvascular endothelium with the retina being the primary site of infection in the eye. Choroidal neovascular membrane (CNVM) is a late complication of ocular toxoplasmosis, mostly occurring in healed, inactive lesions and may be a cause of sudden loss of vision, especially in young patients. However, we report a case of a 22-year-old female who presented to our clinic with CNVM as an early complication. She complained of metamorphopsia and diminished vision in her right eye. Ocular examination, serological investigation and fundoscopy, fundus fluorescein angiography (FFA), axial optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) were carried out and a diagnosis of primary acquired Toxoplasma retinochoroiditis with active CNVM was made. Treatment was commenced with sulfamethoxazole and trimethoprim. Oral prednisolone and intravitreal injection of the anti-vascular endothelial growth factor (anti-VEGF), bevacizumab, were also given. This report describes the rare presentation of ocular toxoplasmosis as a primary lesion in which adjacent pre-existing fundal scarring was absent. The lesion had an acquired etiology in an immunocompetent patient and was complicated early by CNVM.
眼部弓形虫病继发于人体被原生动物寄生虫刚地弓形虫（T. gondii）全身感染之后。该寄生虫对视网膜微血管内皮具有高度亲和力，视网膜是眼部感染的主要部位。脉络膜新生血管膜（CNVM）是眼部弓形虫病的一种晚期并发症，大多发生于愈合的静止性病灶，可能是导致视力突然丧失的原因，尤其在年轻患者中。然而，我们报告了一例22岁女性患者，其以CNVM作为早期并发症前来我院就诊。她主诉右眼视物变形及视力下降。进行了眼部检查、血清学检测以及眼底镜检查、眼底荧光血管造影（FFA）、轴向光学相干断层扫描（OCT）和光学相干断层扫描血管造影（OCTA），诊断为原发性获得性弓形虫视网膜脉络膜炎伴活动性CNVM。开始使用磺胺甲恶唑和甲氧苄啶进行治疗。还给予了口服泼尼松龙以及玻璃体内注射抗血管内皮生长因子（抗VEGF）药物贝伐单抗。本报告描述了眼部弓形虫病罕见地表现为原发性病灶，且不存在相邻的既往眼底瘢痕形成。该病灶在免疫功能正常的患者中具有后天病因，且早期并发CNVM。
