A 9-year-old boy, with no past history of interest, reported myodesopsias of two days' evolution in the left eye.
Ophthalmological examination in the emergency department revealed: visual acuity (VA) in the left eye (LA) 1. Biomicroscopy showed mild anterior uveitis and a funduscopic image of a focus of active chorioretinitis at a diameter of the papilla. Given the characteristics of the focus and its location, a diagnosis of toxoplasmic chorioretinitis was made and treatment was prescribed with oral sulphadiazine, pyrimethamine and folinic acid at doses adjusted per kg of body weight.
After 9 days of treatment, the patient returned to the emergency department with fever of 39º C, papulo-erythematous rash on the chest, back and face, vesicles on the oral mucosa, pneumonitis and balanitis. Ophthalmology showed bilateral upper hyposphagma, membranous conjunctivitis with an exudative component and superficial keratopathy in both eyes.
Blood culture, hepato-renal profile, oral mucosal smear for viruses, herpes and mycoplasma serology were requested. All results were negative and serology for toxoplasma was IgG>500, IgM negative.
In view of the suspicion of JSS secondary to sulphadiazine, all medication for ocular toxoplasmosis was immediately withdrawn and regular check-ups of the ocular fundus were performed, which evolved towards spontaneous healing without complications.
From the day of admission he required exhaustive skin and oral mucosal care, parenteral nutrition and analgesia with intravenous (i.v.) morphine hydrochloride. Subsequently, methylprednisolone 1 mg/kg/day i.v. was added, decreasing the regimen until discharge.
Ophthalmologically, he was prescribed preservative-free artificial tears such as sodium hyaluronate every _ hour, lubricating ointment at night, rifamycin eye drops and dexamethasone every 4 hours to reduce mucosinequiant changes. Symblepharon-lysis is performed every 12 hours of initially very exudative, abundant and easily extractable membranes and later more adherent, fibrous and requiring scarification to remove them.
After 3 weeks of treatment, residual hyposphagma, thickening of the semilunar fold of the inner canthus, keratinisation with thickening of the free edge and slight shortening of the lower fornix were observed.
