背景:眼部弓形虫病是一种罕见的疾病,主要影响儿童和青少年,通常表现为单侧后葡萄膜炎。我们报告了一例与浆液性视网膜脱离相关的弓形虫病患儿。
方法:一名8岁无弓形虫病史的儿童因视力下降1年而被转诊,没有通过光学校正得到改善,检查时玻璃体凝结,没有中枢或外周肉芽肿,OCT上的浆液性视网膜脱离。诊断是经过广泛的询问后做出的,与狗接触和血清学阳性的证据。开始了结合皮质类固醇治疗和抗寄生虫治疗的药物治疗,临床表现有所改善。
结论:眼部弓形虫病是一种罕见的感染,90%的病例是单方面的。其临床表现为小儿扁平疣,后葡萄膜炎与玻璃体视网膜牵引和/或周围肉芽肿相关的后极脉络膜视网膜病灶。在我们的案例中,患者仅出现玻璃体冷凝,OCT浆液性视网膜脱离,无周围性或中央性肉芽肿。阳性血浆血清学或眼部样本证实了诊断。
结论:在没有典型临床表现的情况下,不应排除眼部弓形虫病,和血清阳性可以在临床怀疑时确认诊断。
BACKGROUND: Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment.
METHODS: A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved.
CONCLUSIONS: Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis.
CONCLUSIONS: Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.