Guedes Marta Esteves, Galveia José Nuno, Almeida Ana Catarina, Costa João Marques
Ophthalmology Department, Hospital Egas Moniz, Lisbon, Portugal.
BMJ Case Rep. 2011 Oct 28;2011:bcr0820114654. doi: 10.1136/bcr.08.2011.4654.
Choroidal tuberculosis (TB) infection may present itself as a diffuse choroiditis that resembles serpiginous choroiditis, usually treated with immunossupressants. Recent studies have demonstrated that patients with serpiginous-like choroiditis and evidence of systemic or latent TB are best treated with antituberculosis treatment (ATT) in addition to the corticosteroid therapy. The authors present a case of a 58-year-old man with decreased vision in his left eye. His best-corrected visual acuity was 20/20 right eye and 20/200 left eye. Funduscopic examination revealed a diffuse choroiditis. Mantoux skin test showed an area of induration measuring 30×35 mm and the patient started ATT with complete resolution of retinal lesions after 2 weeks of treatment. His final visual acuity was 20/25 in the left eye with no recurrences over a follow-up of 6 months. The use of ATT in these patients is likely to reduce active inflammation and eliminate future recurrences.
脉络膜结核感染可能表现为类似匐行性脉络膜炎的弥漫性脉络膜炎,通常采用免疫抑制剂治疗。最近的研究表明,患有类似匐行性脉络膜炎且有全身或潜伏性结核证据的患者,除皮质类固醇治疗外,最好采用抗结核治疗(ATT)。作者报告了一例58岁男性患者,其左眼视力下降。他的最佳矫正视力右眼为20/20,左眼为20/200。眼底检查发现弥漫性脉络膜炎。结核菌素皮肤试验显示硬结面积为30×35mm,患者开始接受抗结核治疗,治疗2周后视网膜病变完全消退。他最后的左眼视力为20/25,在6个月的随访中无复发。在这些患者中使用抗结核治疗可能会减轻活动性炎症并消除未来的复发。