Acquired Ocular Toxoplasmosis in a Dermatomyositis Patient with Immunosuppressant Therapy-A Case Report

Abstract

Purpose: To report a case of acquired ocular toxoplasmosis in a patient with dermatomyositis. Method: case report. Result: A 58-year-old male visited our clinic due to progressive blurred vision of the left eye for a month. He had a two-year history of dermatomyositis under immunosuppression therapy. There was a relative afferent papillary defect of the left eye. Ophthalmoscopic examination of the left eye showed a yellow-white retinochoroidal lesion located in the center of the macular region and a white retinochoroidal lesion measuring about 10 disc diameter with vitreous traction at the upper fundus with moderate vitreous opacity. Fluorescein angiography revealed leakage of the retinochoroidal lesion in the late phase. Both serum IgG and IgM showed positive reaction to toxoplasmosis. Antitoxoplasma therapy with oral sulfamethozazole trimethoprim (Baktar) was initiated and the vitreous opacity improved after two weeks. However, after one month of oral Baktar treatment, vitreous hemorrhage was noted and also retinal detachment was found when examining his fundus. The retina was reattached after vitrectomy, lensectomy and silicon oil infusion. His condition was stable thereafter and oral antibiotics were discontinued. Conclusion: Clinical manifestations of ocular toxoplasmosis in immunosuppressed patients present different pictures as in immunocompetent patients. A more fulminant course seemed characteristic of immunosuppressed patients of ocular toxoplasmosis.