Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

Juanarita Jaafar; Wan Hazabbah Wan Hitam; Raja Azmi Mohd Noor

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Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

机译：免疫功能低下患者与结核相关的双侧非典型视神经炎

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A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.

机译：一位27岁的女士，一周右眼突然失去视力。 3天后左眼视力不佳。它涉及整个视野，并伴有眼球运动的疼痛。 4个月前，她被诊断出患有粟粒性结核病和逆转录病毒病。从那时起，她开始接受抗结核病治疗，但默认为高活性抗逆转录病毒疗法（HAART）。经检查，她的视力为右眼无光，左眼为6/120（针孔3/60）。双眼的前段无明显变化。眼底镜检查显示双侧视盘肿胀，周围视网膜中存在多个脉络膜炎灶。玻璃体和视网膜血管正常。胸部X线摄片正常。眼眶和大脑的CT扫描显示双侧视神经鞘膜增强，提示诊断为双侧非典型视神经炎。该患者由传染病小组管理。她开始接受HAART治疗，并继续进行抗结核治疗。 9个月后，她完成了抗结核治疗，没有任何严重的副作用。在随访过程中，两只眼睛的视力没有改善。然而，眼底镜检查显示治疗后椎间盘肿胀和脉络膜炎得以解决。

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《亚太热带生物医学杂志（英文版）》 |2012年第7期|586-588|共3页
作者
Juanarita Jaafar; Wan Hazabbah Wan Hitam; Raja Azmi Mohd Noor;
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Department of 0phthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia;

Department of 0phthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia;

Department of 0phthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia;

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Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

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