title: Fulminant Ocular Toxoplasmosis: The Hazards of Corticosteroid Monotherapy.
abstract: OBJECTIVE
  To describe fulminant toxoplasma retinochoroiditis induced by corticosteroid monotherapy.
  
  
  METHODS
  Clinical records of nine patients were reviewed.
  
  
  RESULTS
  All patients (five female, four male; aged 15-64 years) had been misdiagnosed as unilateral non-infectious uveitis and given systemic and/or local corticosteroid injections elsewhere. Mean disease duration before referral was 105.6 ± 71 (45-240) days. Visual acuity at presentation was <20/200 in six eyes. Average lesion size was 6.6 disc areas in eight eyes and all four quadrants were involved in one. Toxoplasma DNA was detected in eight tested eyes. Mean duration of anti-toxoplasmic therapy was 92.5 ± 37.1 days. Three eyes developed rhegmatogenous retinal detachment. Four patients underwent pars plana vitrectomy. Final visual acuity was <20/200 in five eyes.
  
  
  CONCLUSIONS
  Iatrogenic immunosuppression due to initial misdiagnosis may lead to an aggressive course and serious complications of ocular toxoplasmosis, a potentially self-limiting infection.
authors.affiliation: a Department of Ophthalmology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors.forename: Merih
authors.initials: M
authors.lastname: Oray
authors.affiliation: b Ulucanlar Eye Education and Training Hospital Ophthalmology Clinic , Ankara , Turkey.
authors.forename: Pinar Cakar
authors.initials: PC
authors.lastname: Ozdal
authors.affiliation: a Department of Ophthalmology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Cebeci
authors.affiliation: a Department of Ophthalmology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors.forename: Nur
authors.initials: N
authors.lastname: Kir
authors.affiliation: a Department of Ophthalmology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Tugal-Tutkun
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000633:toxicity; D000328:Adult; D016054:DNA, Protozoan / Q000032:analysis; D003951:Diagnostic Errors / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014126:Toxoplasmosis, Ocular / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014792:Visual Acuity / Q000187:drug effects; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D016054:DNA, Protozoan
keywords: Anti-toxoplasmic therapy; corticosteroid; necrotizing retinitis; ocular toxoplasmosis; retinochoroiditis