Paradoxical growth of presumed optochiasmatic tuberculomas following medical therapy.

Abstract:

IMPORTANCE:Tuberculosis is an endemic infectious disease in developing countries. Patients receiving treatment for systemic tuberculosis may develop paradoxical growth of tuberculomas in the brain, which can lead to vision loss. OBSERVATIONS:We describe 3 patients who had paradoxical development of tuberculomas in the anterior optic pathway during treatment for tuberculosis and presented with acute vision loss. These optochiasmatic tuberculomas were not present at the initial presentation of tuberculosis and appeared on brain magnetic resonance imaging at the time of presentation with vision loss. Vision improved on instituting systemic corticosteroids in addition to antituberculous treatment. CONCLUSIONS AND RELEVANCE:As there was visual recovery after patients began receiving systemic corticosteroids and there was no worsening of the systemic condition, it is reasonable to assume that the optochiasmatic tuberculomas resulted from a paradoxical reaction. It is important to recognize this condition and initiate prompt treatment to reduce visual morbidity.

journal_name

JAMA Ophthalmol

journal_title

JAMA ophthalmology

authors

Joseph M,Mendonca TM,Vasu U,Nithyanandam S,Mathew T

doi

10.1001/jamaophthalmol.2013.4840

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

1463-7

issue

11

eissn

2168-6165

issn

2168-6173

pii

1737424

journal_volume

131

pub_type

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