Khan Perwez, Khan Lubna, Anjum Nikhat, Saxena Nutan
Department of Ophthalmology, GSVM Medical College, Kanpur, India.
Department of Pathology, GSVM Medical College, Kanpur, India.
BMJ Case Rep. 2017 May 12;2017:bcr-2016-216471. doi: 10.1136/bcr-2016-216471.
32-year-old male with diagnosis of central serous chorioretinopathy (CSCR) in both eyes and negative history of administration of any medicine was treated with bilateral focal laser at leakage point, with visual recovery. Recurrence occurred after 2 years in right eye and was treated successfully with acetazolamide. Second recurrence occurred after 1 year. Acetazolamide was restarted, but no improvement was noted. Thorough re-evaluation of the patient revealed a family history of tuberculosis. Ancillary investigations rendered the presumptive diagnosis of tuberculosis, and antituberculosis treatment led to visual recovery with no recurrences. Present case poses two dilemmas: whether CSCR was secondary to tuberculosis or was it an incidental association in tuberculosis endemic population and second whether resolution occurred due to the treatment of tuberculosis or due to mineralo-corticoid antagonism action of rifampicin. Significance of patient's history, clinical observation and angiographic studies in the diagnosis of idiopathic and recurrent CSCR is reiterated.
一名32岁男性,双眼诊断为中心性浆液性脉络膜视网膜病变(CSCR),且无任何用药史,在渗漏点行双眼局部激光治疗后视力恢复。右眼在2年后复发,使用乙酰唑胺成功治疗。1年后再次复发。重新使用乙酰唑胺,但未见改善。对该患者进行全面重新评估发现有结核家族史。辅助检查作出结核的推定诊断,抗结核治疗使视力恢复且未再复发。本病例提出了两个难题:CSCR是继发于结核还是在结核流行地区为偶然关联;其次,视力恢复是由于抗结核治疗还是利福平的盐皮质激素拮抗作用。重申了患者病史、临床观察和血管造影研究在特发性和复发性CSCR诊断中的意义。