Maurice F. Rabb » Diffuse Vasculitis

The patient is a 38 year old male examined April 21, 1980, with five known episodes of uveitis in past experience. The most recent episode was 1975. The present episode began in February, 1980. Previous serological testing was positive for toxoplasmosis. The current reactivation was treated by his local ophthalmologist with high-dose oral steroids without specific toxoplasmosis treatment. He was maintained on just steroid treatment for 2.5 months until the present examination.

Ophthalmoscopic examination: Revealed the vitreous to be extremely cloudy (cells and vitreous aggregates). The retina could be poorly seen through the vitreous haze. On the nasal side of the region of the disc there appeared to be an old pigmented scar with a large necrotic area that extended from this region peripheral to almost the ora serrata.

The patient was treated with six-week therapeutic trial of Clindamycin and Triple Sulfa. The sulfa medication was discontinued by his general physician after two weeks because of the development of a kidney stone.

The patient noticed no significant clearing of the vitreous cavity. Because he was functionally disturbed by the loss of his binocular vision in his occupation, vitrectomy was performed on July 30, 1980. Vitrectomy specimen was positive 1:512 (fluorescent antibody titer). During vitrectomy, all veins and arteries were noted to have excrescences on the surface of the vessels, extending from the disc out to the periphery, with similar excrescences at the edge of the capillary free zone in the macula. There was the appearance, therefore, of a generalized vasculitis. Over the course of postoperative follow-up, the excrescences have decreased somewhat and his vision cleared to 20/20 with a clear media. The latter has occurred without further specific toxoplasmosis therapy and off all steroid medication.