Fulminant Ocular Toxoplasmosis Induced by Aggressive Corticotherapy
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Yes
Purpose
Description of two cases of fulminant atypical toxoplasmic retinochoroiditis induced by aggressive corticosteroid therapy.
Methods
This is a descriptive and retrospective study.
Results
The first case involves a 26-year-old woman being investigated for multiple sclerosis, who developed decreased visual acuity (VA) in the left eye (OS) after pulse therapy with methylprednisolone. The second case is a 55-year-old man with anti-synthetase syndrome, presenting reduced VA in OS after intravitreal dexamethasone implantation in another facility for treatment of presumed non-infectious uveitis. Both patients had extensive necrotizing retinochoroidal lesions. In the second case, the patient was on intravenous acyclovir prescribed by another facility. Fundoscopy of the right eye of the first patient revealed a peridiscal retinochoroidal scar. The second patient had previous descriptions of ocular toxoplasmosis scars in OS. Atypical ocular toxoplasmosis was suspected based on the history, clinical presentation, and positive serology (IgG). In the second case, aqueous humor PCR was performed, confirming the diagnosis and allowing discontinuation of antiviral therapy. Both patients were prescribed treatment with azithromycin, pyrimethamine, and folinic acid, followed by oral corticosteroid therapy and showed resolution of intraocular inflammation.
Conclusion
The inadvertent use of corticosteroids has been associated with more severe intraocular inflammation in patients with infectious uveitis, potentially leading to reactivation and progression to fulminant atypical retinochoroiditis. This requires a high degree of suspicion, molecular diagnosis, and even empirical treatment. Differential diagnosis with viral retinitis is crucial in this context.
Conflict of interest
No
1
Last name
NOBRE MAIA
Initials of first name(s)
Renata
Department
Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais
City
Belo Horizonte
Country
Brazil
2
Last name
Peixoto
Initials of first name(s)
FC
Department
Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais
City
Belo Horizonte
Country
Brazil
3
Last name
Valle
Initials of first name(s)
LA
Department
Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais
City
Belo Horizonte
Country
Brazil
4
Last name
Azevedo
Initials of first name(s)
DOM
Department
Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais
City
Belo Horizonte
Country
Brazil
5
Last name
Vasconcelos-Santos
Initials of first name(s)
DV
Department
Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais
City
Belo Horizonte
Country
Brazil
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