OPTIC NEURITIS OCCURING IN PULMONARY TUBERCULOSIS ON TREATMENTAN IMMUNOLOGICAL REACTIONS?

Abstract

ABSTRACT

Background: Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) is not an uncommon condition occur after initiation of anti-tuberculous drugs commencement. However, optic neuritis occuring in a pulmonary tuberculosis patient as an immunological phenomenon is not common. We report such a case that possesed a diagnostic challenge in a tuberculosis patient.

Materials and Methods:  Case Report

Result: A 63-year-old lady who was diagnosed as pulmonary tuberculosis (sputum AFB positive) was 4 months into treatment when she presented with painless blurring of vision on both eye of 4 days duration. The visual acuity reduced more markedly on her left eye.  She also had scotoma involving upper part of her left visual field. On admission, patient had positive relative afferent pupillary defect over her left eye and fundus examination showed bilateral optic nerve swelling which was worse on the left. Both anterior segments were normal. An urgent CT scan showed no evidence of space occupying lesion and MRI examination was normal. She was started on intravenous methylprednesolon 250mg QID for 5 days and anti-tuberculosis (TB) treatment was  continued. She was discharge with oral prednesolone of 1 mg per kilogram body weight daily on tappering dose over 8 weeks. Her optic nerve functions improved markedly since the third day of intravenous methylprednesolon and bilateral optic disc swelling reduced. Her anti TB treatment were continued for a year.

Conclusion:  Optic  neuritis in tuberculosis can occur in isolation, drug induced, resistant cases, or an immune reconstitution reaction.

Keywords: Optic neuritis, ocular tuberculosis, TB-IRIS.