This 34-year-old man had progressive visual loss in the left eye of 2 months. He was diagnosed with left optic neuritis, and systemic corticosteroids were prescribed. Magnetic resonance imaging of the brain was normal. Automated visual fields were symmetrically normal. After seeking a second opinion 14 days later, best-corrected visual acuity (BCVA) of the left eye was 20/100 (6/30) with diffuse disc elevation and peripapillary nerve fiber hemorrhage (fig. (fig.1a).1a). There was absence of anterior chamber or vitreous flare and cells. He had no afferent pupillary defect and no red color desaturation. He had fluorescein dye leakage from the optic disc (fig. (fig.2a).2a). There was no evidence of retinal vasculitis. Optical coherence tomography (OCT) demonstrated optic nerve head swelling and thickening (fig. (fig.3a).3a). Visual acuity was normal in the right eye with negative findings by 90-diopter slit-lamp exam, visual acuity, OCT, and fluorescein angiography. Detailed medical history was positive for a cough productive of clear sputum of recent duration, nonsmoking status, no exposure to cats, no ingestion of raw meat, and no extramarital relations. Tuberculosis was suspected. Physical exam and infectious workup were essentially negative (HIV, VDRL, Borrelia burgdorferi, Brucella, angiotensin-converting enzyme) including chest radiograph and chest CT. Purified protein derivative (PPD) skin test was strongly positive. Ten days after the initial consult, BCVA deteriorated further to 20/200 (6/60) in the left eye with increased disc swelling. He was started on treatment for presumed optic disc tuberculoma consisting of 2 months of rifampin, isoniazid, pyrazinamide, and ethambutol (respective doses: 150, 75, 400, and 275 mg) followed by 4 months of rifampin and isoniazid. One week after initiation of quadruple antituberculous therapy, vision improved to 20/30 (6/9) with decreased disc swelling. BCVA in the left eye was 20/20 (6/6) 2 weeks after initiation of therapy with a marked decrease in both disc elevation (fig. (fig.1b)1b) and fluorescein leakage (fig. (fig.2b).2b). Three months after initiation of therapy, funduscopy and OCT (fig. (fig.3b)3b) returned to normal. At follow-up 4 months after initiation of therapy, visual fields were unchanged. At the last follow-up 10 months after initiation of therapy, clinical examination was unchanged....
Below: a Fundus photograph. Posterior pole of the left eye demonstrates marked swelling of the optic disc with peripapillary hemorrhage. b Fundus photograph. Posterior pole of the left eye 2 weeks after initiation of antimycobacterial therapy shows marked resolution of the optic disc swelling.
Full article
at:
By:
aDepartment of Ophthalmology, American
University of Beirut, Saudi Arabia
bDepartment of Internal Medicine, Infectious
Disease Service, American University of Beirut, Saudi Arabia
cDepartment of Ophthalmology and, Rafic
Hariri University Hospital, Beirut, Lebanon, Saudi Arabia
dDepartment of Internal Medicine, Rafic
Hariri University Hospital, Beirut, Lebanon, Saudi Arabia
eDepartment of The Eye Center and the Eye
Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
fDepartment of Ophthalmology, College of
Medicine, King Saud University, Riyadh, Saudi Arabia
gThe Wilmer Ophthalmological Institute of
the Johns Hopkins University School of Medicine, Baltimore, Md., USA
More at: https://twitter.com/hiv_insight
No comments:
Post a Comment