Sadek Khaled W, Atta Mohamed A, Sultan Najwa Y, Ashour Anas A
Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
Faculty of Pharmacy, Hama University, Hama, Syria.
Case Rep Neurol. 2024 Jan 9;16(1):18-27. doi: 10.1159/000536086. eCollection 2024 Jan-Dec.
Tuberculosis (TB) is a major global cause of morbidity and mortality. TB meningitis (TBM) is an implication of systemic dissemination of a primary TB infection that indicates a poorer disease prognosis with various long-term neurological sequelae. Consequently, it is crucial to understand the different clinical presentations and manifestations of such condition. In TBM, vision loss, which is one of the most devastating complications, may result from optic nerve inflammation and atrophy. Although unilateral optic neuritis as a primary presenting symptom of TBM has been broadly reported in the literature, there is a paucity of information related to several other rare neuro-ophthalmic features, such as bilateral optic nerve involvement in TBM.
We herein present a case of a 37-year-old Indian male patient presenting with unilateral vision loss that subsequently progressed to bilateral vision loss and was hence diagnosed with bilateral optic neuritis. Additional thorough investigation yielded a diagnosis of TBM with underlying tuberculomas. The patient's condition improved afterward with anti-tuberculous therapy and steroids with follow-up magnetic resonance imaging indicating radiological resolution as well.
The differential diagnosis of bilateral optic neuritis is broad but rare, yet an overlooked one would be central nervous system TB in the form of meningitis or tuberculoma. Hence, it is important to identify bilateral optic neuritis as a possible rare presenting symptom of an underlying central nervous system TB infection which could lead to a faster disease diagnosis and treatment to prevent its devastating complications.
结核病是全球发病和死亡的主要原因。结核性脑膜炎（TBM）是原发性结核感染全身播散的一种表现，提示疾病预后较差，会出现各种长期神经后遗症。因此，了解这种疾病的不同临床表现至关重要。在TBM中，视力丧失是最具破坏性的并发症之一，可能由视神经炎症和萎缩引起。虽然单侧视神经炎作为TBM的主要首发症状在文献中已有广泛报道，但关于其他一些罕见的神经眼科特征的信息却很少，比如TBM中的双侧视神经受累。
我们在此报告一例37岁印度男性患者，最初表现为单侧视力丧失，随后发展为双侧视力丧失，最终被诊断为双侧视神经炎。进一步的全面检查确诊为伴有潜在结核瘤的TBM。经抗结核治疗和使用类固醇药物后，患者病情好转，后续磁共振成像显示放射学上也已恢复。
双侧视神经炎的鉴别诊断范围广泛但较为罕见，然而被忽视的一种情况是以脑膜炎或结核瘤形式出现的中枢神经系统结核。因此，将双侧视神经炎识别为潜在中枢神经系统结核感染的一种可能的罕见首发症状很重要，这有助于更快地诊断和治疗疾病，以预防其毁灭性并发症。
