Fatimah-Halwani Ismail, Wahab Zulaikha, Masnon Nurul Ain, Wan Hitam Wan-Hazabbah, Shatriah Ismail, Haron Juhara
Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, MYS.
Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, MYS.
Cureus. 2022 Aug 2;14(8):e27600. doi: 10.7759/cureus.27600. eCollection 2022 Aug.
Optic perineuritis (OPN) in pulmonary tuberculosis (PTB) patients while on anti-tuberculous treatment is rare. It may occur due to tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS). Visual prognosis is poor if not treated early. We report a rare case of bilateral OPN in an elderly patient on treatment for PTB. A 79-year-old Malay man presented with a painless bilateral blurring of vision for three weeks. He was diagnosed to have PTB and has been on anti-tuberculous treatment for five months. Visual acuity in both eyes was only counting fingers. Optic nerve function tests were significantly reduced bilaterally. Fundoscopy showed bilateral segmental temporal optic disc pallor. Both visual field assessments were constricted. Other infective screenings and tumor markers were negative. Neuro-imaging revealed bilateral OPN involving the intraorbital segment. High-dose intravenous corticosteroid therapy was commenced, followed by slow tapering of oral prednisolone. Anti-tuberculous treatment was continued for a total course of nine months. The left visual acuity improved to 3/60. However, the right eye vision remained poor. His general condition was good.
肺结核（PTB）患者在接受抗结核治疗时发生视神经周围炎（OPN）的情况较为罕见。它可能是由于结核免疫重建炎症综合征（TB-IRIS）引起的。如果不及早治疗，视力预后较差。我们报告了一例老年PTB患者发生双侧OPN的罕见病例。一名79岁的马来男性，出现无痛性双侧视力模糊三周。他被诊断为患有PTB，且已接受抗结核治疗五个月。双眼视力仅为眼前手动。双侧视神经功能测试显著降低。眼底检查显示双侧节段性颞侧视盘苍白。双眼视野评估均有缺损。其他感染筛查和肿瘤标志物均为阴性。神经影像学检查显示双侧OPN累及眶内段。开始给予大剂量静脉注射皮质类固醇治疗，随后逐渐减量口服泼尼松龙。抗结核治疗持续九个月的全疗程。左眼视力提高到3/60。然而，右眼视力仍然很差。他的一般状况良好。
