Kharel Sitaula Ranju, Agrawal Preeti
Department of Ophthalmology, Maharajgunj Medical Campus, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal.
Ann Med Surg (Lond). 2022 Jul 31;80:104294. doi: 10.1016/j.amsu.2022.104294. eCollection 2022 Aug.
& IMPORTANCE: Ocular tuberculosis and Vogt Koyanagi Harada disease (VKHD) both are the important cause of panuveitis. In tubercular endemic region like Nepal, latent tuberculosis (TB) may be accompanied with the features of VKHD. Hence, the aim of our publication is the use the term Tubercular Harada disease (THD) for such panuveitis with mixed features.
We aim to report two cases of panuveitis from Nepal with the simultaneous features of tuberculous uveitis and Harada disease managed with combined antitubercular agents and antimetabolites.
Two cases presented with bilateral decreased vision with no systemic associations. They had bilateral panuveitis and sunset glow. Ultrasonography showed the choroidal thickening, optical coherence tomography confirmed macular edema with retinal nerve fibre layer edema. Electroretinogram of both eyes showed reduced P1 wave amplitude. All the systemic investigations were normal except the positive tuberculin skin test and TB QuantiFERON Gold test.Both of them were managed with intravenous/oral corticosteroid (1mg/kg) along with CAT- I ATT regimen (2HRZE+7HR) for 9 months and oral antimetabolites (azathioprine or methotrexate). Long term follow-up showed normal visual acuity with no evidence of recurrence of uveitis.
Mycobacterium could have triggered the onset of Harada disease in TB endemic country like Nepal leading to simultaneous presentation of Tubercular Harada Disease.
及重要性：眼结核和伏格特-小柳-原田病（VKHD）均是全葡萄膜炎的重要病因。在尼泊尔这样的结核病流行地区，潜伏性结核（TB）可能伴有 VKHD 的特征。因此，我们发表此文的目的是将具有混合特征的此类全葡萄膜炎称为结核性原田病（THD）。
我们旨在报告两例来自尼泊尔的全葡萄膜炎病例，其同时具有结核性葡萄膜炎和原田病的特征，采用联合抗结核药物和抗代谢药物进行治疗。
两例患者均表现为双侧视力下降，无全身相关症状。他们患有双侧全葡萄膜炎和晚霞样改变。超声检查显示脉络膜增厚，光学相干断层扫描证实黄斑水肿伴视网膜神经纤维层水肿。双眼视网膜电图显示 P1 波振幅降低。除结核菌素皮肤试验和结核感染 T 细胞检测呈阳性外，所有全身检查均正常。他们均接受静脉/口服皮质类固醇（1mg/kg）以及一线抗结核治疗方案（2HRZE + 7HR）9 个月，并口服抗代谢药物（硫唑嘌呤或甲氨蝶呤）。长期随访显示视力正常，无葡萄膜炎复发迹象。
在尼泊尔这样的结核病流行国家，分枝杆菌可能引发了原田病的发病，导致结核性原田病同时出现。
