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BRIEF COMMUNICATIONS
Year : 2017  |  Volume : 65  |  Issue : 8  |  Page : 761-764

Paradoxical worsening of a case of TB subretinal abscess with serpiginous-like choroiditis following the initiation of antitubercular therapy


Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamilnadu, India

Correspondence Address:
Sudha K Ganesh
Department of Uveitis, Medical Research Foundation, Sankara Nethralaya, No 18, College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_184_17

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A 37-year-old immunocompetent male patient presented with the blurring of vision, both eyes for the past1 year. Fundus examination revealed bilateral multiple subretinal abscesses with areas of healed serpiginous-like choroiditis. Laboratory investigations showed positive tuberculin skin test, positive QuantiFERON TB-Gold Test, and high resolution computed tomography chest showed enlarged mediastinal lymph nodes. The aqueous sample revealed polymerase chain reaction (PCR) positive for Mycobacterium tuberculosis (MTB) (MPB64 genome). He was treated antitubercular therapy (ATT) along with oral steroids. Although he responded well initially, he had recurrent inflammation and paradoxical worsening. This was managed with a high dose of intravenous corticosteroids, immune suppressive and ATT. He also had a diagnostic vitreous biopsy which was also PCR positive for MTB (IS6110 gene). He subsequently continued ATT along with corticosteroids and immune suppressive and responded well. We present this case report for its unusual presentation.


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