Dutta Majumder Parthopratim, Ali Sowkath, Biswas Jyotirmay
Medical and Vision Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, 600 006, India.
J Ophthalmic Inflamm Infect. 2017 Dec;7(1):12. doi: 10.1186/s12348-017-0131-6. Epub 2017 May 22.
Sarcoidosis and tuberculosis (TB) share epidemiological, immunological, and molecular features common to both, and often, it becomes difficult to differentiate them especially in a highly TB-endemic country like India. We report a case of optic disc granuloma along with epididymitis and infertility in a male who showed a response to treatment with anti-tuberculosis therapy and steroids.
A 35-year-old Indian male who presented with complaints of blurring vision in the right eye for 6 months and treated elsewhere with two intravitreal injections of anti-VEGF was found to have optic disc granuloma in the right eye. His investigations revealed highly positive Mantoux test, negative QuantiFERON test, elevated serum ACE, and HRCT of chest showing features of sarcoidosis. He also gave a history of primary infertility. Ultrasound Doppler of the scrotum was suggestive of epididymitis. After getting a chest physician opinion, the patient was started on the first line of ATT followed by oral steroids. On subsequent follow-up visits, the patient showed resolution of lesions along with the return of fertility.
The index case of optic disc granuloma along with epididymitis had features of both tuberculosis and sarcoidosis and falls in the gray zone of tuberculous sarcoidosis and showed a response to both ATT and corticosteroids. We report this case report for its unique presentation.
结节病和结核病在流行病学、免疫学和分子特征方面存在共同之处，在像印度这样结核病高发的国家，往往很难区分它们。我们报告一例男性患者，患有视盘肉芽肿并伴有附睾炎和不育症，该患者对抗结核治疗和类固醇治疗有反应。
一名35岁的印度男性，因右眼视力模糊6个月就诊，此前在其他地方接受了两次玻璃体内注射抗血管内皮生长因子治疗，检查发现右眼有视盘肉芽肿。他的检查显示结核菌素试验强阳性、全血γ干扰素释放试验阴性、血清血管紧张素转换酶升高，胸部高分辨率计算机断层扫描显示有结节病特征。他还自述有原发性不育症。阴囊超声多普勒检查提示附睾炎。在获得胸科医生的意见后，患者开始接受一线抗结核治疗，随后口服类固醇。在随后的随访中，患者的病变消退，生育能力恢复。
该例视盘肉芽肿合并附睾炎的病例具有结核病和结节病的特征，属于结核结节病的灰色地带，对抗结核治疗和皮质类固醇治疗均有反应。我们报告该病例是因其独特的表现。
