Title: Concurrent Occurrence of Choroidal, Optochaismatic and Intracranial Tuberculomas: A Paradoxical Reaction of Anti Tubercular Drugs
Authors: Pratibha Prasad, Vikas Kumar Gupta, Amita Bhargava, Khichar Shubhakaran
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.45
Abstract
Paradoxical response in CNS tuberculosis poses a diagnostic challenge in the management. We describe a 35 year-old immunocompetent female with documented tubercular meningitis with normal fundus and visual acuity without any history of tuberculosis and antitubercular drugs therapy (ATT),being treated with first line ATT, who 4 months later ,developed visual impairment in both eyes. Funduscopy showed the presence of a choroidal tuberculoma in her left eye. Brain MRIs revealed multiple tuberculomas intracranially and around the optic chaisma. ATT with addition of high dose steroid was continued. Following 2 years, she had no visual deficit. She was diagnosed with concurrent development of intracranial, optochaismatic and choroidal tuberculomas as a paradoxical reaction to ATT which is a rare occurrence and is yet not reported to our knowledge .Visual impairment developing in a patient on treatment with ATT should give rise to a suspicion of rare occurrence of optochiasmatic and choroidal tuberculomas thus preventing vision loss.
Keywords: Choroidal , optochaismatic tuberculoma, intracranial tuberculoma,
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