Author: Selma Chiguer (Morocco)
Co-authors: Zakaria Cheikh, Amine Hammouch, Adil Mchachi, Leila Benhmidoune, Rayad Rachid, Mohamed Elbelhadji
Purpose
Neuroretinitis is characterized by optic disc edema, peripapillary and macular subretinal and intraretinal exudates, with subsequent formation a complete or partial macular star, due to an infection (Bartonella henselae, Treponema pallidum, Toxoplasma gondii) or autoimmune disorders. Neuroretinitis as ocular manifestation of Mycobacterium tuberculosis infection is uncommun. We report the case of a patient with unilateral neurotinitis revealing multifocal tuberculosis
Setting/Venue
Adult Ophthalmology Department, 20 August 1953 Hospital / Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Methods
We report the case of a 62 years old diabetic woman, living in rural area. She was admitted for abrupt visual loss on the left side associated with asthenia and headaches without any other signs. There was no evidence of personal or familial tuberculosis contagion.
Results
Best-corrected visual acuity was 6/10 on the right eye and 1/10 on the left eye. In both, pupillary reflex and intraocular pressure were normal. Examination of the right eye was normal. But, in the left eye we found optic disc edema, subretinal exudats and a partial macular star. Search for syphilis, bartonellosis, toxoplasmosis and VIH serology was negative. Chest radiograph was also done and didn’t show any abnormalities. Since, Morocco remains an endemic country of tuberculosis; intradermic reaction of tuberculine was performed in this patient and was highly positif. Investigations were pursued by thoracic CT scan which found patterns of ganglionnar and pulmonary tuberculosis. Mycobacterium tuberculosis was then isolated in the bronchoalveolar lavage and confirmed the diagnosis of multifocal tuberculosis. The patient received antibiotics according to the Morrocan treatment guidelines of tuberculosis. It consists of 2 months of intensive phase with rifampicin, isoniazid , pyrazinamide and ethambutol and other 4 months of maintenance phase with only rifampicin and isoniazid.
Conlusions
Ocular tuberculosis is uncommon and can take on different aspects posing the problem of differential diagnosis and making its diagnosis a real challenge. Moreover, the visual prognosis depends on the initiation of an appropriate treatment allowing stabilization or visual improvement.
Financial Disclosure
No financial relations
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