J Korean Ophthalmol Soc.  2013 Mar;54(3):508-512. 10.3341/jkos.2013.54.3.508.

Occlusive Retinal Vasculitis Associated with Intravenous Ceftriaxone Injection

• Seok JY
• Lee SJ
• Oh MJ
• Lee SY

• KMID: 2216774
• DOI: http://doi.org/10.3341/jkos.2013.54.3.508

Abstract

PURPOSE
To report a case of bilateral occlusive retinal vasculitis presumed to be associated with intravenous ceftriaxone injection.
CASE SUMMARY
A 26-year-old woman presented with a sudden visual impairment which developed 2 days earlier in her left eye combined with an anaphylactoid reaction. The patient was administered intravenous ceftriaxone (2 g / day) 9 times for 14 days due to aggravation of chronic osteomyelitis on her left ankle. There were no adverse events until the 7th intravenous ceftriaxone administration. However, anaphylactoid reactions occurred shortly after the 8th and 9th administration. On the 1st visit, her best corrected visual acuity in the right eye was 1.0, and in the left eye 0.1. On fundus examination, retinal hemorrhages and perivascular sheathing were observed in the superonasal area in the right eye and in the entire retina in the left eye. Anterior chamber cell reactions were not noted on slit lamp examination, and vitritis was absent in both eyes. Laboratory data showed no conclusive evidence of autoimmune or origin of infection. On the last visit, 25 months after the initial visit, the patient's best corrected visual acuity was 0.02 in the left eye and visual acuity and fundus appearance were normal in the right eye.
CONCLUSIONS
Bilateral occlusive retinal vasculitis may be associated with intravenous ceftriaxone injection, and immunological and serological tests should be performed thoroughly along with history taking to clarify the cause of retinal vasculitis.

Keyword

Ceftriaxone; Drug allergy; Hypersensitivity; Retinal vasculitis

MeSH Terms

Animals
Ankle
Anterior Chamber
Ceftriaxone
Drug Hypersensitivity
Eye
Female
Humans
Hypersensitivity
Osteomyelitis
Retina
Retinal Hemorrhage
Retinal Vasculitis
Retinaldehyde
Serologic Tests
Vision Disorders
Visual Acuity
Ceftriaxone
Retinaldehyde

Figure

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  Figure 1. Fundus photographys at initial visit. (A) Fundus photograph of right eye shows perivascular sheathing with intraretinal hemorrhages in superonasal area. (B) Fundus photograph of left eye shows perivascular sheathing with intraretinal hemorrhages in entire retina.

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  Figure 2. Fluorescein angiographys (FA) of both eyes 2 months after onset. (A) Late-phase FA in the right eye shows normal fundus. (B) Late-phase FA in the left eye shows hyperfluorescence due to vascular leakage in the peripapillary area and cystoid macular edema, extensive non-perfusion areas around the midperiphery of the entire fundus, and blocked fluorescence due to preretinal hemorrhages.

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  Figure 3. Fundus photographys 3 months after initial visit. (A) Fundus photograph of right eye shows no active lesion. (B) Fundus photograph of left eye shows proliferative fibrous membrane and neovascularization on disc, and decreased retinal hemorrhages.

Reference

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