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,
References
- Tsai MH, Huang YC, Lin TY. Development of tuberculoma during therapy presenting as hemianopsia. Pediatr Neurol 2004: 31(5):360-363.
- Ahmetgjekaj I, Muqaj Ks, Lascu Cl . Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis. Current Health Sciences Journal 2014: 40( 3): 225-227.
- Pauranik A, Behari M, Maheshwari MC. Appearance of tuberculomas during treatment of tuberculous meningitis. Jpn J Med 1987: 26:332-4.
- Gupta M et al Paradoxical Response in Patients with CNS Tuberculosis. JAPI 2003: 51: 257-260.
- Ajay SK, Lakhkar BB, Bhaskaranand N. Intracranial tuberculoma manifesting during treatment. Indian Paediatrics 1996: 33:231-3.
- Teoh R, Humphries MJ, O’Mahony G. Symptomatic intracranial tuberculoma developing during treatment of tuberculosis - A report of 10 patients and review of literature. Q J Med 1987: 241:449-60.
- Marshall BG, Chambers MA. Central nervous system tuberculosis - the paradox of the host immune response. J Infect 1998: 36:3-4.
- Van Bommel EF, Stiegelis WF, Schermers HP. Paradoxical response of intracranial tuberculomas during chemotherapy: an immunologic phenomenon? Neth J Med 1991: 38:126-30.
- Rahajoe NN.Miliary tuberculosis in children. A clinical review. Paediatr Indones. 1990: 30(9- 10):233-240.
- Semlali S, El-Quassar A, Atmane M, Benkirane N, Chakir N, El-Hassani M, Benchekroune N, Berraho- Hamani A, Jiddane M. Pseudotumoral form of sclerochoroidal tuberculosis: a case report. J Radiol 2004:85:131-134.
Corresponding Author
Pratibha Prasad
D.M. Neurology, Senior Resident, Department of Neurology
Dr. S.N. Medical College , Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.