A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.Interestingly, there was no development of vitritis throughout.
Bilateral Retinal Vasculitis: A Presumed Case of Ocular TB without Inflammation
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Abstrak
Seorang pelajar berusia 17 tahun berketurunan Indonesia mengadu kehilangan penglihatan di kedua-dua belah mata selama dua minggu. Tiada kontak dengan pesakit tuberculosis (TB) dilaporkan dan ibu-bapanya menyatakan pesakit mendapat imunisasi lengkap termasuk BCG. Walaubagaimanapun, tiada kesan parut BCG kelihatan. Penglihatan pesakit adalah 6/36 dan 6/60 untuk mata kanan dan kiri. Ruang hadapan dan vitreous mata tiada radangan. Pemeriksaan funduskopi menyerlahkan vaskulitits retina, kebocoran saluran darah, vena tersumbat, saluran darah baru dan makula bengkak. Angiografi menggunakan fluorescein mengesahkan kawasan kapilari yang tidak mendapat perfusi. Ujian Mantoux adalah positif dan pesakit diberikan ubat anti- TB. Ujian HIV adalah negatif. Tiga hari kemudian, ubat antiradang diberikan. Pesakit juga menerima laser di kedua-dua belah matanya. Tiada terdapat radangan vitrius sepanjang pesakit menerima rawatan.
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