Bilateral Retinal Vasculitis: A Presumed Case of Ocular TB without Inflammation

Bilateral Retinal Vasculitis
Vol. 7 No. 2 : 2012 (97-101)

UMI KALTHUM MN UMI KALTHUM MN
NORFARIZAL A NORFARIZAL A
RONA ASNIDA N RONA ASNIDA N
AYESHA MZ AYESHA MZ
JEMAIMA CH JEMAIMA CH

Abstract
A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.Interestingly, there was no development of vitritis throughout.

Keywords : blurring of vision, fluorescein angiography, laser,

Correspondance Address
Dr. Umi Kalthum Md Noh, Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur. Tel: 603-91455981. Fax: 603-91456733. Email: umi_fizul@yahoo.com


References
Alvarez, G.G., Roth, V.R., Hodge, W. Ocular tuberculosis: diagnostic and treatment challenges. Int J Infect Dis. 2009;13(4):432-435. Dolin, P.J., Raviglione, M.C., Kochi, A. 1994. Global tuberculosis incidence and mortality during 1990-2000. Bull World Health Organ 72(2): 213-220. Gupta, A., Gupta, V., Arora, S., Dogra, M.R., Bambery, P. 2001. PCR-positive tubercular retinal vasculitis: clinical characteristics and management. Retina 21(5): 435-444. Helm, C.J., Holland, G.N. 1993. Ocular tuberculosis. Surv Ophthalmol 38(3): 229- 256. Kurup, S.K., Chan, C.C. 2006. Mycobacterium-related ocular inflammatory disease: diagnosis and management. Ann Acad Med Singapore 35(3): 203-209. Nayak, S., Acharjya, B. 2012. Mantoux test and its interpretation. Indian Dermatol Online J 3(1): 2-6. Neunhöffer, H., Gold, A., Hoerauf, H., Herbort, C., Heiligenhaus, A., Zimmermann, O., Feltgen, N. 2013. Isolated ocular Jarisch-Herxheimer reaction after initiating tuberculostatic therapy in a child. Int Ophthalmol, in press. Nissapatorn, V., Lim, Y.A.L., Jamaiah, I., Man Chin, H., Ilyana, M.Z., Nonaziah, M.Z., Siti Hasifah, A., Kuppusamy, I. Tuberculosis in Malaysia, a continuous surge. Southeast Asian J Trop Med Public Health. 2007; 38: 231- 239 Rutherford, M., Alisjahbana, B., Maharani, W., Sampurno, H., van Crevel, R., Hil, P.C. 2010. Sensitivity of the quantiferon-gold in-tube assay in sputum smear positive TB cases in Indonesia. PLoS One 5(8): e12020. Sheu, S.J., Shyu, J.S., Chen, L.M., Chen, Y.Y., Chirn, S.C., Wang, J.S. 2001. Ocular manifestations of tuberculosis. Ophthalmology 108(9): 1580- 1585. Simsek, H., Alpar, S., Ucar, N., Aksu, F., Ceyhan, I., Gözalan, A., Cesur, S., Ertek, M. 2010. Comparison of tuberculin skin testing and T- SPOT.TB for diagnosis of latent and active tuberculosis. Jpn J Infect Dis 63(2): 99-102. Thompson, M.J., Albert, D.M. 2005. Ocular tuberculosis. Arch Ophthalmol 123(6): 844- 849.