Ocular sarcoidosis masked by positive IgM for toxoplasmosis

ABSTRACT We report a case of ocular sarcoidosis with positive immunoglobulin (Ig) M and IgG serology for toxoplasmosis. The patient was a young female with red painful eyes, bilateral eyelid edema, and panuveitis with periphlebitis. In laboratory testing, she was IgM and IgG positive for toxoplasmosis and anergic in the tuberculin test. Topical treatment for anterior uveitis and oral antibiotics for toxoplasmosis were started, without improvement. Orbit tomography showed increased lacrimal glands bilaterally, and chest X-ray radiographic findings were consistent with pulmonary sarcoidosis, which supported the presumed ocular sarcoidosis diagnosis. The patient was treated with oral prednisone and methotrexate without antibiotics. She showed clinical and vision improvement without recurrences during the 1-year follow-up. Ocular sarcoidosis is an important differential diagnosis requiring careful anamnesis and ophthalmological examinations. Ancillary tests, such as X-ray radiography, tomography, and clinical and laboratory evaluations may help rule out other causes. Treatment mainly consists of corticosteroids and immunosuppression.

摘要
本文报告1例弓形虫病（toxoplasmosis）血清学免疫球蛋白M（IgM）与免疫球蛋白G（IgG）均呈阳性的眼结节病（ocular sarcoidosis）病例。患者为年轻女性，表现为眼红伴疼痛、双侧眼睑水肿，以及合并静脉周围炎（periphlebitis）的全葡萄膜炎（panuveitis）。实验室检查显示其弓形虫病IgM、IgG均为阳性，结核菌素试验（tuberculin test）呈无反应性。予前部葡萄膜炎（anterior uveitis）局部治疗及弓形虫病口服抗生素治疗后，患者症状无改善。眼眶断层成像（orbit tomography）显示双侧泪腺增大，胸部X线影像学表现符合肺结节病（pulmonary sarcoidosis），进一步支持疑似眼结节病的诊断。遂予口服泼尼松（prednisone）与甲氨蝶呤（methotrexate）治疗，未联用抗生素。患者临床症状及视力均获改善，1年随访期间未出现复发。眼结节病是重要的鉴别诊断病种，需完善详细病史采集与眼科检查。辅助检查如X线摄影、断层成像及临床与实验室评估可辅助排除其他病因。治疗主要以糖皮质激素（corticosteroids）与免疫抑制疗法（immunosuppression）为主。