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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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

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