Khalili Pour Elias, Riazi-Esfahani Hamid, Ebrahimiadib Nazanin, Esteghamati Violet Zaker, Zarei Mohammad
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Imam Khomeini General Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Case Rep Ophthalmol Med. 2021 May 1;2021:5512408. doi: 10.1155/2021/5512408. eCollection 2021.
The aim is to report an atypical presentation of ocular toxoplasmosis which led to the diagnosis of Acquired Immunodeficiency Syndrome (AIDS). . The 38-year-old woman was referred with metamorphopsia and reduced vision in the right eye over the past 3 weeks. Slit-lamp examination revealed granulomatous keratic precipitates (KPs), 2+ cells in the anterior chamber, and posterior synechiae. Fundus examination was remarkable for a white patch surrounding a scar, inferonasal to the optic disc with fibrous bands emanating from the lesion, and the retina around this region was detached with considerable extension towards the periphery, while no breaks could be appreciated. She mentioned anorexia and losing 10 kg in the past three months, and signs of anemia like paleness of face skin, bed nails, and bilateral angular cheilitis were observed on systemic evaluation. The results of the patient's complete blood count revealed anemia and leukopenia and CD4 lymphocytes: 79 cells/L. Enzyme-linked immunosorbent assays (ELISA) for HIV antibodies came back positive which was later confirmed with the Western blot test. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices. The patient underwent antitoxoplasmosis and anti-HIV treatment and serous retinal detachment completely resolved.
This report highlights the fact that sometimes, the eyes are the site of the first presentation of a systemic life-threatening condition and emphasizes the role of ophthalmologists in such cases. In cases of atypical presentation, appropriate laboratory tests and CNS imaging should be requested. Systemic treatment with antitoxoplasmosis regimens and highly active antiretroviral therapy (HAART) is mandatory in AIDS patients with ocular toxoplasmosis.
目的是报告一例导致获得性免疫缺陷综合征（AIDS）诊断的眼部弓形虫病非典型表现。一名38岁女性因过去3周出现视物变形和右眼视力下降前来就诊。裂隙灯检查发现肉芽肿性角膜后沉着物（KPs）、前房2+细胞及虹膜后粘连。眼底检查发现视盘鼻下侧有一个围绕瘢痕的白色斑块，病变处有纤维条索，该区域周围视网膜脱离并向周边有相当程度的延伸，但未见裂孔。她提到过去三个月有厌食且体重减轻10千克，全身评估时观察到贫血迹象，如面部皮肤苍白、匙状甲和双侧口角炎。患者全血细胞计数结果显示贫血和白细胞减少，CD4淋巴细胞计数为79个/微升。HIV抗体酶联免疫吸附试验（ELISA）结果呈阳性，随后经蛋白印迹试验确认。脑部磁共振成像（MRI）显示双侧大脑皮质有多个环形强化病灶。患者接受了抗弓形虫病和抗HIV治疗，浆液性视网膜脱离完全消退。
本报告强调了有时眼睛是全身性危及生命疾病首发部位这一事实，并强调了眼科医生在此类病例中的作用。对于非典型表现的病例，应进行适当的实验室检查和中枢神经系统成像检查。对于患有眼部弓形虫病的AIDS患者，必须采用抗弓形虫病方案进行全身治疗以及高效抗逆转录病毒治疗（HAART）。
