유리체강 내 덱사메타손임플란트삽입술 후 발생한 전격 톡소플라즈마 맥락망막염
Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 초기 치료 후 안정을 보이는 톡소플라즈마 맥락망막염환자에서 유리체강 내 덱사메타손 임플란트삽입술을 단독 시행한 후 전격톡소플라즈마 맥락망막염으로 진행한 1예를 보고하고자 한다. 증례요약: 60세 건강한 여자 환자가 3주 전부터 시작된 좌안 시력 저하를 주소로 내원하였다. 안저검사에서 황백색 침윤을 동반한국소 맥락망막염이 관찰되어 시행한 혈청학검사를 포함한 혈액검사에서 특이 소견은 발견되지 않았으나 임상적으로 톡소플라즈마맥락망막염이 의심되어 항생제와 스테로이드 경구 요법을 시행하였다. 이후 호전을 보였으나 추적 관찰이 중단되었고, 재발을 보이는유리체 염증에 대해 타 병원에서 유리체강 내 덱사메타손 임플란트 단독 삽입술을 시행받은 후 광범위한 침윤을 동반한 괴사성 망막염의 진행을 보여 재의뢰되었다. 임플란트 제거 및 정확한 진단을 위해 유리체절제술을 시행하였고 중합효소연쇄반응 검사를 통해톡소플라즈마증 확진 후 항생제 투여로 안정되었다. 결론: 초기 치료 후 안정을 보이는 전형적 톡소플라즈마 맥락망막염환자에서 적절한 항생제 유지 없이 염증 조절을 위해 유리체강내 덱사메타손 임플란트를 삽입하는 경우 전격 톡소플라즈마 맥락망막염으로 진행할 수 있어 주의가 필요하다.
Abstract
Purpose: To report a case of fulminant toxoplasmic chorioretinitis following intravitreal dexamethasone implantation monotherapy in a stabilized toxoplasmic chorioretinitis patient with initial treatment. Case summary: A 60-year-old healthy female presented with decreased visual acuity in the left eye. On fundus examination, focal chorioretinitis and yellow-white infiltration were observed. Laboratory work-up, including blood chemistry, complete blood count, and serum serology, was negative; however, toxoplasmic chorioretinitis could not be ruled out. The primary lesion improved with antibiotics and prednisolone treatment. However, the patient did not come in for her follow-up visit, as she had already received an intravitreal dexamethasone implant for recurrent vitreous inflammation elsewhere. On her return, she presented with necrotic retinitis with extensive infiltration. She underwent diagnostic vitrectomy and implant removal. A diagnosis of toxoplasma antigen was confirmed by polymerase chain reaction analysis; the lesions stabilized after anti-toxoplasmic therapy. Conclusions: Intravitreal dexamethasone implant monotherapy with stabilized toxoplasmic chorioretinitis without systemic antibiotics can lead to fulminant toxoplasmic chorioretinitis and should be used with caution.
참고문헌 (15)
- Cunningham ET Jr, "Ocular toxoplasmosis", Ocul Immunol Inflamm, 23, pp.191~193 (2015)
- 박영훈, "Clinical Features of Ocular Toxoplasmosis in Korean Patients", Parasites, Hosts and Diseases, 49(2), pp.167~171 (2011), 대한기생충학ㆍ열대의학회
- Rothova A, "Therapy for ocular toxoplasmosis", Am J Ophthalmol, 115, pp.517~523 (1993)
- Young-Hoon Park, "Clinical Features and Treatment of Ocular Toxoplasmosis", Parasites, Hosts and Diseases, 51(4), pp.393~399 (2013), 대한기생충학ㆍ열대의학회
- Holland G, "An update on current practices in the management of ocular toxoplasmosis", Am J Ophthalmol, 134, pp.102~114 (2002)
- Oray M, "Fulminant ocular toxoplasmosis : the hazards of corticosteroid monotherapy", Ocul Immunol Inflamm, 24, pp.637~646 (2016)
- Papadia M, "The role of serology in active ocular toxoplasmosis", Int Ophthalmol, 31, pp.461~465 (2011)
- Suresh S, "Serological IgG avidity test for ocular toxoplasmosis", Clin Ophthalmol, 6, pp.147~150 (2012)
- De Groot-Mijnes JD, "Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis", Am J Ophthalmol, 141, pp.313~318 (2006)
- Sugita S, "Diagnosis of ocular toxoplasmosis by two polymerase chain reaction(PCR)examinations : qualitative multiplex and quantitative real-time", Jpn J Ophthalmol, 55, pp.495~501 (2011)
- Takakura A, "Viral retinitis following intraocular or periocular corticosteroid administration : a case series and comprehensive review of the literature", Ocul Immunol Inflamm, 22, pp.175~182 (2014)
- Backhouse O, "Intravitreal triamcinolone acetonide as an adjunct in the treatment of severe ocular toxoplasmosis", Eye, 22, pp.1201~1202 (2008)
- Zamora YF, "Local treatment of toxoplasmic retinochoroiditis with intravitreal clindamycin and dexamethasone", Arq Bras Oftalmol, 78, pp.216~219 (2015)
- O'Connor GR, "Editorial: dangers of steroid treatment in toxoplasmosis. periocular injections and systemic therapy", Arch Ophthalmol, 94, pp.213~ (1976)
- Rush R, "Fulminant toxoplasmic retino-choroiditis following intravitreal triamcinolone administration", Indian J Ophthalmol, 60, pp.141~143 (2012)