J Korean Ophthalmol Soc.  2019 Sep;60(9):896-900. 10.3341/jkos.2019.60.9.896.

Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

• Jeong A
• Park DG
• Sagong M

• KMID: 2459136
• DOI: http://doi.org/10.3341/jkos.2019.60.9.896

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.

Keyword

Dexamethasone implant; Intravitreal injection; Toxoplasma gondii; Toxoplasmic chorioretinitis; Toxoplasmosis

MeSH Terms

Anti-Bacterial Agents
Blood Cell Count
Chemistry
Chorioretinitis*
Dexamethasone*
Diagnosis
Female
Follow-Up Studies
Humans
Inflammation
Intravitreal Injections
Middle Aged
Polymerase Chain Reaction
Prednisolone
Retinitis
Toxoplasma
Toxoplasmosis
Visual Acuity
Vitrectomy
Anti-Bacterial Agents
Dexamethasone
Prednisolone

Figure

• 

  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.

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