An unusual case of tuberculous optic neuropathy associated with choroiditis

Abstract

Tuberculous optic neuropathy that includes papillitis, neuroretinitis, and optic nerve tubercle is a rare presentation of ocular tuberculosis. Though contagious spread from choroid following the hematogenous dissemination of the bacilli has been implicated in the optic nerve involvement, unlike neuroretinitis, optic nerve and choroidal involvement are usually considered as two separate clinical entities. We report a case of optic nerve involvement in a 33-year-old male who had concurrent choroidal involvement at present and also in the past. A strong history of contact with patients of pulmonary tuberculosis, positive tuberculin skin test, interferon gamma release assay, and high-resolution computed tomography helped us to clinch the diagnosis. Patients responded to systemic corticosteroid therapy and anti-tuberculosis treatment. Choroidal involvement in a case of inflammatory optic neuropathy should arise suspicion of tuberculous etiology.

Optic disc granuloma: A rare presentation of tuberculosis

“…Optic disc granuloma may rarely be the presenting sign of ocular tuberculosis (TB). [ 1 2 3 4 5 6 ] However, it should always be considered a differential diagnosis to the more commonly reported sarcoid disc granuloma, in patients living in endemic areas. Here, we report such a case of optic disc granuloma treated as suspected ocular TB.…”

“…Among these few case reports, the visual prognosis has been reported ranging from guarded to good. [ 1 2 3 4 5 6 ]…”

Commentary: Tuberculosis in neuro ophthalmology - How different it is?

“…Other causes of choroidal granulomas include sarcoidosis, syphilis and fungal lesions. [3] In practice, delineating tuberculosis related optic neuropathy[4] includes individualized work up on all the differentials such as infectives (syphilis, toxoplasmosis, cat scratch disease, Lyme disease, leptospirosis, systemic fungal infection, HIV-associated disease), systemic inflammatory diseases (multiple sclerosis, neuromyelitis optica, sarcoidosis, Vogt-Koyanagi-Harada disease, Behçet's disease, other systemic vasculitidies) ocular inflammatory conditions (uveitis and posterior scleritis); and vascular, neoplastic, toxic and hereditary forms of optic neuropathy as well.…”