J Korean Ophthalmol Soc.  2021 Nov;62(11):1565-1569. 10.3341/jkos.2021.62.11.1565.

Recurrent Toxoplasma Retinitis Treated with Long-Term Oral Antibiotics

• Yeom H
• Park SH
• Cho H
• Shin YU

• KMID: 2522335
• DOI: http://doi.org/10.3341/jkos.2021.62.11.1565

Abstract

Purpose
The purpose of this case was to report the inhibition of toxoplasma retinitis reactivation with long-term, low-dose antibiotics.
Case summary
A 76-year-old woman complained of poor vision and floaters in her right eye. The corrected visual acuity (LogMAR) of the right eye was 0.5, and there was an area of yellow infiltration and dye leakage on the retinal fluorescein angiography images. Toxoplasma IgG were detected in the serum, the patient was diagnosed with toxoplasma retinitis, and the patient was advised oral trimethoprim-sulfamethoxazole, clindamycin, and steroids. Her visual acuity improved and the inflammation resolved. However, she again had decreased visual activity and retinal inflammation in her right eye after 5 months. The inflammation improved with oral steroids, but she was shifted to intravitreal dexamethasone because of the side effects of systemic steroids. Although the inflammation improved initially, there was worsening of inflammation (evidenced by vitreous opacity) after 2 months, which was treated with oral antibiotics. After vitrectomy for the removal of residual vitreous opacity, antibiotics were stopped because of the stable disease course. After discontinuation of the antibiotics, inflammation was noted again, and low-dose trimethoprim-sulfamethoxazole was administered. Low-dose antibiotics were continued for 5 months and the disease remained stable without any retinal inflammation.
Conclusions
Long-term, low-dose oral antibiotics may prevent reactivation of recurrent toxoplasma retinitis.

Keyword

Dexamethasone implant, Long-term trimethoprim-sulfamethoxazole, Toxoplasma retinitis, Toxoplasmic chorioretinitis, Toxoplasmosis