Sinner Veronika, Rüesch Reinhard, Valmaggia Christophe, Todorova Margarita
Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.
Klin Monbl Augenheilkd. 2020 Apr;237(4):493-496. doi: 10.1055/a-1112-7155. Epub 2020 Mar 27.
To describe choroidal findings associated with disseminated systemic non-mycobacterial infection.
A retrospective observational case series included two patients (four eyes) with non-tuberculous mycobacterial disease. The activity of choroidal lesions was assessed by clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, indocyanine green angiography, fluorescence angiography, and optical coherence tomography (OCT) angiography. The relationships between clinical symptomatology, choroidal findings, and systemic disease activity were evaluated.
One subject diagnosed with aortic graft infection showed positive cultures for Mycobacterium chimaera. One HIV-positive subject showed a positive saliva culture for Mycobacterium avium. At presentation, all subjects showed chorioretinal manifestation. In one patient, the lesions were active and in the other patient, the lesions appeared inactive. With activity of disseminated chorioretinitis, the lesions had indistinct, blurred borders on fluorescence angiography and indocyanine green angiography and were hyporeflective with well-defined borders on OCT imaging.
Multimodal imaging enables distinction between active and inactive lesions, thus supporting therapeutic management. Choroidal presentation of active disseminated mycobacterium infection indicates activity of systemic disease. Thus, even if the patient is not immunocompromised, an underlying systemic involvement should be ruled out.
描述与播散性系统性非分枝杆菌感染相关的脉络膜表现。
一项回顾性观察病例系列研究纳入了两名患有非结核分枝杆菌病的患者（四只眼）。通过临床检查评估脉络膜病变的活性，并辅以彩色眼底照相、眼底自发荧光成像、吲哚菁绿血管造影、荧光血管造影和光学相干断层扫描（OCT）血管造影。评估临床症状、脉络膜表现与全身疾病活性之间的关系。
一名被诊断为主动脉移植感染的受试者，其培养物中分离出嵌合体分枝杆菌。一名HIV阳性受试者的唾液培养物中鸟分枝杆菌呈阳性。就诊时，所有受试者均表现出脉络膜视网膜病变。一名患者的病变为活动性，另一名患者的病变表现为非活动性。随着播散性脉络膜视网膜炎的活动，病变在荧光血管造影和吲哚菁绿血管造影上边界不清、模糊，在OCT成像上边界清晰但反射率降低。
多模态成像能够区分活动性和非活动性病变，从而有助于治疗管理。活动性播散性分枝杆菌感染的脉络膜表现提示全身疾病的活动。因此，即使患者没有免疫功能低下，也应排除潜在的全身受累情况。
