Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

Areum Jeong; Dong-Geun Park; Min Sagong

doi:10.3341/jkos.2019.60.9.896

Journal List > J Korean Ophthalmol Soc > v.60(9) > 1133044

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Jeong, Park, and Sagong: Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(9): 896-900.

Published online: 18 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.9.896

Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

Areum Jeong, MD, Dong-Geun Park, MD, Min Sagong, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

Address reprint requests to Min Sagong, MD, PhD. Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3443, Fax: 82-53-626-5936, msagong@ynu.ac.kr

Received 10 January 2019 Revised 17 March 2019 Accepted 16 August 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Dexamethasone implant, Intravitreal injection, Toxoplasma gondii, Toxoplasmic chorioretinitis, Toxoplasmosis

Figures and Tables

Figure 1

A 60-year-old female patient with hypertension had a small focus of active chorioretinitis of the left eye. (A) Initial ultra- widefield imaging of left eye showed yellow-whitish lesion with infiltration. (B) After 1 month of oral antibiotics and prednisolone, the lesion was decreased. (C) After intravitreal dexamethasone implantation, yellow-whitish lesion and multiple retinal hemorrhages were present. Dexamethasone implant (white arrow) was seen in vitreous. (D) After 2 weeks of intravitreal ganciclovir injection, the lesion and infiltrations increased. (E) Three weeks after intravitreal ganciclovir injection, severe retinitis and new whitish lesion (at 7 o’clock) were detected. (F) After 8 weeks of oral trimethoprim-sulfamethoxazole and clindamycin therapy, chorioretinal scar was remained but inflammation was not seen.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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