Bilateral optic neuritis secondary to presumed ocular tuberculosis in immunocompetent adults

This case series aims to discuss cases of bilateral optic neuritis secondary to presumed ocular tuberculosis (TB) in two immunocompetent adults. Ocular TB has been associated with optic neuritis, but bilateral cases in immunocompetent individuals are rarely seen. We report a case series of two young healthy adults with bilateral painless optic neuritis as the presenting feature of ocular TB. Clinical examination, TB tests, and angiographic studies supported the diagnosis. All patients were started on anti-TB medication followed by oral prednisolone and had visual improvement a few weeks after treatment. As a conclusion, these cases highlight an atypical case of ocular TB presentation in immunocompetent individuals and thorough investigation is pertinent to preserve the visual function.

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Efficacy for the Annual Relapse Rate after the Immunosuppressive Therapy in Patients Associated with Anti-AQP4 or Anti-MOG Antibody-Positive Optic Neuritis

Journal of Ophthalmology ◽

10.1155/2020/8871146 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Sotaro Mori ◽

Takuji Kurimoto ◽

Yusuke Murai ◽

Kaori Ueda ◽

Mari Sakamoto ◽

...

Keyword(s):

Optic Neuritis ◽

Immunosuppressive Therapy ◽

Relapse Rate ◽

Case Series ◽

Oral Prednisolone ◽

University Hospital ◽

Double Positive ◽

Before And After ◽

The Impact ◽

Aqp4 Antibody

Purpose. Although oral prednisolone is the first-line treatment for preventing recurrent optic neuritis (ON) after the completion of acute-phase treatment, especially anti-aquaporin 4 (AQP4) antibody-positive ON, and anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON, some patients experience relapses. Immunosuppressants could be effective in reducing the recurrence rate for neuromyelitis optica spectrum disorder and MOG antibody-related diseases, but there have been few studies addressing this issue focusing on the changes in ophthalmic parameters. The objective of the study was to analyze the impact of off-label uses of immunosuppressants to reduce recurrent ON. Design. Retrospective observational study, clinical case series. Methods. We reviewed the medical charts of 11 cases (22 eyes) who underwent immunosuppressive therapy in Kobe University Hospital and compared the annualized relapse rate (ARR) before and after immunosuppressive therapy. We also evaluated the dosage of prednisolone, complications of immunosuppressants, and other visual functional ophthalmologic parameters. Results. Eleven cases in total had AQP4 antibody (9 cases) and/or MOG antibody (3 cases). One case was double positive for these antibodies. Nine patients received azathioprine and two received mycophenolate mofetil as an initial immunosuppressive therapy. The median duration of immunosuppressant treatment was 2.8 years. The median ON ARR before immunosuppressive therapy was 0.33, and this decreased significantly to 0 after the therapy ( p = 0.02 ). The dose of prednisolone was reduced from 17.8 ± 7.1 mg/day before to 5.8 ± 2.2 mg/day after immunosuppressive therapy ( p < 0.01 ). Although two patients presented with mild elevation of liver enzymes and nausea, all patients were able to continue taking the immunosuppressants. Conclusions. Immunosuppressants can potentially decrease relapses and steroid dosage in patients with anti-AQP4 or MOG antibody-positive ON without severe adverse events and the exacerbation of visual acuities.

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Intraocular tuberculosis, a challenge in diagnosis and treatment

Latin American Journal of Ophthalmology ◽

10.25259/lajo_17_2019 ◽

2020 ◽

Vol 3 ◽

pp. 4

Author(s):

Martina Larroude ◽

Gustavo Ariel Budmann

Keyword(s):

Developing Countries ◽

Clinical Signs ◽

Steady Increase ◽

Ocular Tuberculosis ◽

Industrial Countries ◽

Choroidal Granuloma ◽

History Of ◽

And Migration ◽

Ocular Tb

Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition and has variable manifestations. The incidence of TB is still high in developing countries, and a steady increase in new cases has been observed in industrial countries as a result of the growing number of immunodeficient patients and migration from developing countries. Choroidal granuloma is a rare and atypical location of TB. We present a case of a presumptive choroidal granuloma. This case exposes that diagnosis can be remarkably challenging when there is no history of pulmonary TB. The recognition of clinical signs of ocular TB is extremely important since it provides a clinical pathway toward tailored investigations and decision making for initiating anti-TB therapy and to ensure a close follow-up to detect the development of any complication.

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