Retinal Occlusive Vasculitis Secondary to Tuberculosis – A Clinical Report

• Main Authors: Irina Ramos Gomes, Vanda Nogueira
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: The Pan-American Journal of Ophthalmology
• Subjects: vitreous hemorrhage; retinal vasculitis; ocular tuberculosis; anti-tuberculosis therapy.
• Online Access: http://www.thepajo.org/article.asp?issn=2666-4909;year=2017;volume=16;issue=3;spage=90;epage=93;aulast=Gomes;type=0

Purpose: To report the case of a patient with persistent vitreous hemorrhage in the right eye (RE) caused by occlusive retinal vasculitis secondary to tuberculosis. Methods: Male patient, 35 years old, with Indian ancestry, no history of previous systemic illness. First presented to our outpatient clinic with decreased visual acuity in the RE, lasting eight months. On exam, best-corrected visual acuity (BCVA) RE was <5/200 and BCVA in the left eye (LE) was 20/20. Keratic precipitates were visible and anterior chamber flare was described as 1+; extensive vitreous hemorrhage was present precluding fundus observation. Fundus fluorescein angiography (FFA) performed on his LE was normal. He was started on topical steroids and submitted to pars plana vitrectomy plus intraoperative retinal photocoagulation on his RE for peripheral retinal ischemia. Results: Post-surgery exam, BCVA in the RE was 20/100 and the LE was 20/20, no anterior chamber reaction bilaterally. Macular edema with exuberant vascular tortuosity and “phantom” vessels in RE. FA confirmed active occlusive vasculitis on the RE. Diagnostic workup was positive for a 28mm induration tuberculin test, supporting the diagnosis of ocular tuberculosis. The patient was started on anti-tuberculosis medication. Three months later, BCVA in the RE was 20/25 with no anterior chamber reaction in both eyes. Eighteen months later, the patient maintains good bilateral visual acuity without any evidence of disease reactivation. Conclusions: In the described clinical case, there was a good response after anti-tuberculosis treatment not associated with oral corticosteroid therapy, with improved visual acuity and remission of inflammatory angiographic signs, stressing the importance of searching tuberculosis etiology in cases of retinal vasculitis.