Bartimote Christopher, Fraser-Bell Samantha, Dunn Hamish
Ophthalmology, Royal North Shore Hospital, Sydney, Australia.
The University of Sydney, Sydney, Australia.
Respir Med Case Rep. 2021 Jun 24;33:101456. doi: 10.1016/j.rmcr.2021.101456. eCollection 2021.
Worldwide, tuberculosis is the leading cause of death from an infectious disease. Ocular involvement can cause significant and permanent vision loss. Ocular manifestations of tuberculosis often present with visual symptoms. Asymptomatic ocular tuberculosis is uncommon and yet can have serious consequences if missed.
An immunocompetent 26-year-old Filipino man living in regional Australia who was diagnosed with active pulmonary tuberculosis and started on antitubercular therapy. He was referred to an ophthalmologist for baseline ethambutol screening to exclude pre-existing optic neuropathy. Despite having no visual symptoms, when examined, the patient had vision threatening occlusive retinal vasculitis. He was initially commenced on localised therapy via bevacizumab intravitreal injections and retinal photocoagulation. Following completion of antitubercular therapy, high dose prednisone was commenced and slowly tapered.
We present the case of an asymptomatic sight threatening occlusive vasculitis that was discovered on pre-treatment ophthalmology review. This case emphasises the need for referral for full ophthalmic screening in newly diagnosed tuberculosis to exclude vision-threatening complications.
在全球范围内，结核病是传染病致死的主要原因。眼部受累可导致严重且永久性视力丧失。结核病的眼部表现常伴有视觉症状。无症状性眼部结核并不常见，但如果漏诊可能会产生严重后果。
一名居住在澳大利亚地区的26岁免疫功能正常的菲律宾男子，被诊断为活动性肺结核并开始接受抗结核治疗。他因进行基线乙胺丁醇筛查以排除既往存在的视神经病变而被转诊至眼科医生处。尽管没有视觉症状，但检查时发现该患者患有威胁视力的闭塞性视网膜血管炎。他最初通过玻璃体腔内注射贝伐单抗和视网膜光凝进行局部治疗。抗结核治疗完成后，开始使用高剂量泼尼松并逐渐减量。
我们报告了一例在治疗前眼科检查时发现的无症状性威胁视力的闭塞性血管炎病例。该病例强调了新诊断结核病患者需要转诊进行全面眼科筛查以排除威胁视力的并发症。
