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Ngathaweesuk Y, Janthayanont S, Keorochana N. Characteristics and outcomes of the duration of treatment with adjunctive corticosteroids in intraocular tuberculosis. J Clin Tuberc Other Mycobact Dis 2024; 35:100439. [PMID: 38646417 PMCID: PMC11031803 DOI: 10.1016/j.jctube.2024.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Introduction Intraocular tuberculosis (IOTB) is a common site of extrapulmonary tuberculosis and a main cause of infectious uveitis. It can result in severe visual morbidity if not recognized and treated properly. The clinical manifestations of IOTB are varied, and the duration of treatment is unclear. This study describes the clinical characteristics and outcomes of patients with IOTB and compares the duration of antituberculosis therapy (ATT) and steroid use. Method An 8-year retrospective study of IOTB patients in an endemic area of a tertiary hospital in Thailand. All patients had a complete treatment of ATT at least for 6 months. Results Forty-three patients with 57 eyes and a mean age of 43.72 years were included. Panuveitis (38.6 %), retinal phlebitis (31.6 %), and posterior uveitis (15.8 %) were common clinical characteristics. A significant difference between initial and final best corrected visual acuity (BCVA) after ATT in 6 months for therapy and at least 9 months for therapy was observed (p = 0.004, 0.003, respectively). Ninety point nine percent of patients who received ATT for 9 months achieved a successful treatment outcome, while 66.7 % of patients who received ATT for 6 months did (p = 0.056). Patients who received systemic and/or regional corticosteroids therapy during treatment had a higher rate of treatment failure (p < 0.001). Conclusion IOTB had a variety of clinical manifestations, including nongranulomatous inflammation. Patients who completed treatment with ATT for at least 6 months improved their final BCVA. There was no difference in treatment outcomes regarding the duration of treatment. Combined treatment with systemic and/or regional corticosteroids was significantly associated with failed treatment outcomes.
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Affiliation(s)
- Yaninsiri Ngathaweesuk
- Ocular inflammatory and uveitis division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Narumon Keorochana
- Ocular inflammatory and uveitis division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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2
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Abera MT, Fetene MB, Kassa NB, Yaynishet YA, Tefera TG, Hailu SS. Intraocular tuberculosis masquerading as ocular tumor: A case report. Radiol Case Rep 2024; 19:1949-1955. [PMID: 38434778 PMCID: PMC10909611 DOI: 10.1016/j.radcr.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Tuberculosis is one of the most common pediatric problems, especially in the developing world. In spite of that, intraocular tuberculosis is a rare disease that can easily be confused with other noninfectious processes, even in regions where tuberculosis is rampant. Diagnosis is difficult, yet it is very important to provide effective antituberculosis treatment and avoid potentially sight-losing interventions. We present a case of a 2-year-old child with a positive contact history of tuberculosis who presented with progressively worsening seizures and constitutional symptoms for 6 months. Brain computed tomography revealed right frontotemporal region conglomerated ring-enhancing lesions with central necrosis consistent with tuberculosis. On the same scan, a calcified right retinal lesion with a contrast-enhancing soft tissue component was identified. A chest radiograph and abdominal sonography showed evidence of disseminated tuberculosis. Subsequently, antituberculosis treatment was initiated, and the right retinal lesion improved, thus leading to the imaging diagnosis of right intraocular tuberculosis. Early and accurate diagnosis of retinal tuberculosis is of paramount importance in avoiding potentially catastrophic interventions. Neuroimaging is a useful, noninvasive method to consider this difficult diagnosis and also for follow-up.
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Affiliation(s)
| | - Misganaw Badege Fetene
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Nibretu Bekele Kassa
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Yodit Abraham Yaynishet
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Tesfaye Gizaw Tefera
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Samuel Sisay Hailu
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
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Chadalawada S, Rathinam SR, Lalitha P, Kannan NB, Devarajan B. Detection of microRNAs expression signatures in vitreous humor of intraocular tuberculosis. Mol Biol Rep 2023; 50:10061-10072. [PMID: 37906423 DOI: 10.1007/s11033-023-08819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND MicroRNA (miRNA) expression analysis has been shown to provide them as biomarkers in several eye diseases and has a regulatory role in pathogenesis. However, miRNA expression analysis in the vitreous humor (VH) of intraocular tuberculosis (IOTB) is not studied. Thus, we aim to find miRNA expression signatures in the VH of IOTB patients to identify their regulatory role in disease pathogenesis and to find them as potential biomarkers for IOTB. METHODS AND RESULTS First, we profiled miRNAs in VH of three IOTB and three Macular hole (MH) samples as controls through small-RNA deep sequencing using Illumina Platform. In-house bioinformatics analysis identified 81 dysregulated miRNAs in IOTB. Further validation in VH of IOTB (n = 15) compared to MH (n = 15) using Real-Time quantitative PCR (RT-qPCR) identified three significantly upregulated miRNAs, hsa-miR-150-5p, hsa-miR-26b-5p, and hsa-miR-21-5p. Based on the miRNA target prediction, functional network analysis, and RT-qPCR analysis of target genes, the three miRNAs downregulating WNT5A, PRKCA, MAP3K7, IL7, TGFB2, IL1A, PRKCB, TNFA, and TP53 genes involving MAPK signaling pathway, PI3K-AKT signaling pathway, WNT signaling pathway, Cell cycle, TGF-beta signaling pathway, Long-term potentiation, and Sphingolipid signaling pathways, have a potential role in disease pathogenesis. The ROC analysis of RT-qPCR data showed that hsa-miR-150-5p with AUC = 0.715, hsa-miR-21-5p with AUC = 0.789, and hsa-miR-26b-5p with AUC = 0.738; however, the combination of hsa-miR-21-5p and hsa-miR-26b-5p with AUC = 0.796 could serve as a potential biomarker for IOTB. CONCLUSIONS This study provides the first report on miRNA expression signatures detected in VH for IOTB pathogenesis and also provides a potential biomarker for IOTB.
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Affiliation(s)
- Swathi Chadalawada
- Department of Microbiology and Bioinformatics, Aravind Medical Research Foundation, 1, Anna Nagar, Madurai, India
- Biomedical Sciences, Madurai Kamaraj University, Madurai, 625021, Tamil Nadu, India
| | - S R Rathinam
- Uveitis Service, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Prajna Lalitha
- Department of Microbiology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Naresh Babu Kannan
- Chief, Retina Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Bharanidharan Devarajan
- Department of Microbiology and Bioinformatics, Aravind Medical Research Foundation, 1, Anna Nagar, Madurai, India.
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Hassan LM, Asaad A, ElSanabary Z, Youssef MM. Evaluation of the retinal and choroidal microvasculature changes in cases of sarcoid and tuberculosis-associated posterior uveitis using OCT angiography. Int Ophthalmol 2023; 43:597-608. [PMID: 36029353 PMCID: PMC9971116 DOI: 10.1007/s10792-022-02464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Using optical coherence tomography angiography (OCTA) to evaluate retinal microvascular changes in sarcoid and tuberculous (TB) posterior uveitis. METHODS Cross-sectional observational study includes 30 eyes. FFA and OCTA images were acquired. OCTA images were analyzed for areas of capillary hypo-perfusion, disorganization of the superficial and deep capillary plexuses (SCP and DCP) and intraretinal cystoid spaces and for measuring the size of the foveal avascular zone and vessel density (VD) in the SCP and DCP. RESULTS A total of 11 eyes were associated with TB and 19 with sarcoidosis. By OCTA, 100% had areas of capillary non-perfusion, 36.7% choroidal voids, 30% disorganization of the SCP and DCP and 26.6% intraretinal cystoid spaces. The VD of the DCP was significantly lower in the TB group. On comparing OCTA and FFA, parafoveal ischemia was detected more frequently on OCTA and macular edema more frequently on FFA (P = < 0.001). The BCVA was not significantly correlated with the VD of the SCP or DCP. CONCLUSION OCTA can be used in detection of early microvascular changes, segmenting retinal layers and localizing abnormalities. The presence of these changes may aid in the diagnosis of TB and sarcoid uveitis, for prognosis, follow-up and may be the only choice when FFA is contraindicated.
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Affiliation(s)
| | | | - Zeinab ElSanabary
- grid.7776.10000 0004 0639 9286Cairo University, 3 Road 217, Degla Maadi, Cairo, 11431 Egypt
| | - Maha M. Youssef
- grid.7776.10000 0004 0639 9286Cairo University, 3 Road 217, Degla Maadi, Cairo, 11431 Egypt
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Chadalawada S, Kathirvel K, Lalitha P, Rathinam SR, Devarajan B. Dysregulated expression of microRNAs in aqueous humor from intraocular tuberculosis patients. Mol Biol Rep 2021. [PMID: 34677715 DOI: 10.1007/s11033-021-06846-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Systemic Mycobacterium tuberculosis (Mtb) infection alters microRNA's expression that controls cellular processes and modulates host defense mechanisms. However, the role of miRNAs in intraocular tuberculosis (IOTB) remains unknown. Therefore, this study aims to identify dysregulated miRNAs in the aqueous humor (AH) of patients with IOTB. METHODS AH from intraocular tuberculosis patients (n = 2) and cataract controls (n = 2) were used for small RNA deep sequencing using HiSeq Illumina sequencing platform. Differentially expressed miRNAs and their targets were identified by the bioinformatics approach, and their regulatory functions were predicted by pathway enrichment analysis. The expression of selected miRNAs and their binding targets were further validated by real-time quantitative PCR (RT-qPCR). RESULTS In total, we identified 56 differentially expressed miRNAs in the AH of intraocular tuberculosis (IOTB) patients compared to controls. We selected four significantly dysregulated miRNAs (miR-423-5p, miR-328-3p, miR-21-5p, and miR-16-5p) based on the RT-qPCR validation and predicted their gene targets. We developed a miRNA-targets regulatory network by combining pathways of interest and genes associated with TB. We identified that these four miRNAs might play an important role in IOTB pathogenesis via tuberculosis-associated pathways; PI3K-Akt signaling, autophagy and MAPK pathway. CONCLUSIONS For the first time, this study identifies the dysregulation of four miRNAs in the AH of IOTB patients using the ultra-low input small-RNA sequencing approach. Further target prediction and validation identify the role of these miRNAs in tuberculosis pathogenesis via tuberculosis-related pathways. This study identifies miRNAs as potentially ideal biomarkers in the aqueous humor of IOTB patients.
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Zhang YK, Fu HY, Guan Y, Li YJ, Bai HZ. Concurrent tuberculous chorioretinitis with choroidal neovascularization and tuberculous meningitis: a case report. BMC Ophthalmol 2020; 20:227. [PMID: 32532239 PMCID: PMC7291746 DOI: 10.1186/s12886-020-01504-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a severe health burden worldwide. The manifestation of concurrent tuberculous cerebral and ocular involvements associated with TB is uncommon. CASE PRESENTATION We report a 17-year-old girl with concurrent tuberculous cerebral and ocular involvements and visual impairment due to choroidal neovascularization. This study emphasizes the definite diagnosis with the combination of ophthalmological examination, multimodal imaging and routine tuberculosis testing, and the proper management with intravitreal anti-VEGF injection accompanied by systemic anti-tuberculosis therapy. CONCLUSION Combined applications of routine TB tests, fundus multimodal imaging and diagnostic therapy greatly help the clinician to establish a precise diagnosis and in monitoring the therapeutic response.
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Affiliation(s)
- Yan-Kun Zhang
- Department of Ophthalmology, Hebei Chest Hospital, Shijiazhuang, 050000, China
| | - Hong-Yi Fu
- Department of Tuberculosis, Hebei Chest Hospital, Shijiazhuang, 050000, China
| | - Yan Guan
- Department of Ophthalmology, Hebei Chest Hospital, Shijiazhuang, 050000, China
| | - Yu-Jing Li
- Clinical Laboratory, Hebei Chest Hospital, Shijiazhuang, 050000, China
| | - Hong-Zhong Bai
- Department of Radiology, Hebei Chest Hospital, Shijiazhuang, 050000, China.
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Venkatesh R, Sangai S, Pereira A, Mahendradas P, Yadav NK. Acute macular neuroretinopathy with coexistent central retinal vein occlusion as the presenting feature in intraocular tuberculosis. J Ophthalmic Inflamm Infect 2020; 10:10. [PMID: 32103362 PMCID: PMC7044390 DOI: 10.1186/s12348-020-00201-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/19/2020] [Indexed: 11/24/2022] Open
Abstract
Aim To report a case of intraocular tuberculosis presenting as acute macular neuroretinopathy and central retinal vein occlusion. Case description A 29-year-old man presented to the retina clinic with complaints of sudden blurring of vision in the left eye of 3 days duration. His visual acuity was 6/6 and 6/18 in the right and left eye, respectively. Fundus examination of the left eye showed features of central retinal vein occlusion. OCT showed features of type 2 acute macular neuroretinopathy (AMN) as well. Over a period of 2 weeks, the patient developed choroidal granulomas with overlying retinal elevation and peripapillary choroidal neovascular membrane and retinal granuloma. Mantoux test and HRCT chest confirmed the diagnosis of pulmonary tuberculosis. Results The patient was treated with a course of antitubercular therapy, oral corticosteroids and a single dose of intravitreal anti-vascular endothelial growth factor (1.25 mg/0.05 ml Bevacizumab, Roche Pharma) injection. After 6 months of therapy with ATT and tapering course of oral steroids, there was a complete resolution of all clinical signs including the choroidal granuloma with an improvement in visual acuity to 6/6. Conclusion Acute macular neuroretinopathy can complicate intraocular TB. Tuberculosis should be kept as one of the differential diagnosis in patients with AMN. Prognosis is generally good in patients of ocular TB presenting with retinal vascular occlusions.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina, Vitreous and Ocular Inflammation, Narayana Nethralaya, #121/C, 1st R block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India.
| | - Sajjan Sangai
- Department of Retina, Vitreous and Ocular Inflammation, Narayana Nethralaya, #121/C, 1st R block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Arpitha Pereira
- Department of Retina, Vitreous and Ocular Inflammation, Narayana Nethralaya, #121/C, 1st R block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Padmamalini Mahendradas
- Department of Retina, Vitreous and Ocular Inflammation, Narayana Nethralaya, #121/C, 1st R block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
| | - Naresh Kumar Yadav
- Department of Retina, Vitreous and Ocular Inflammation, Narayana Nethralaya, #121/C, 1st R block, Chord Road, Rajaji Nagar, Bengaluru, 560010, India
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8
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Basu S, Fowler BJ, Kerur N, Arnvig KB, Rao NA. NLRP3 inflammasome activation by mycobacterial ESAT-6 and dsRNA in intraocular tuberculosis. Microb Pathog 2017; 114:219-224. [PMID: 29180292 DOI: 10.1016/j.micpath.2017.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 01/08/2023]
Abstract
The molecular basis of intraocular tuberculosis (TB) is not well understood. In this study, we investigated the role of two constituents of viable Mycobacterium tuberculosis - Early Secreted Antigenic Target-6 (ESAT-6), and mycobacterial RNA- in inflammasome activation in the retinal pigment epithelium (RPE), a key site of inflammation in intraocular TB. We found that ESAT-6 induced caspase-1 activation and inflammasome priming in mouse RPE cells, substantially more in wild-type than in Tlr2/3/4/7/9-/-, Myd88-/- or Nlrp3-/- RPE cells. Sub-retinal ESAT-6 injection resulted in greater RPE degeneration in wild-type than in Nlrp3-/- mice. In human ocular TB tissue sections, NLRP3 staining was noted in retina as well as RPE. Mycobacterial RNA, specifically its double stranded component, also induced caspase-1 activation, and the double stranded RNA was immunolocalized to human ocular TB sections. Our observations suggest that inflammasome activation in RPE by viable M. tuberculosis could potentially contribute to human intraocular TB.
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MESH Headings
- Animals
- Antigens, Bacterial/genetics
- Antigens, Bacterial/immunology
- Bacterial Proteins/genetics
- Bacterial Proteins/immunology
- Caspase 1/genetics
- Caspase 1/immunology
- Host-Parasite Interactions
- Humans
- Inflammasomes/genetics
- Inflammasomes/immunology
- Mice
- Mice, Inbred C57BL
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/immunology
- NLR Family, Pyrin Domain-Containing 3 Protein/genetics
- NLR Family, Pyrin Domain-Containing 3 Protein/immunology
- RNA, Bacterial/genetics
- RNA, Bacterial/immunology
- RNA, Double-Stranded/genetics
- RNA, Double-Stranded/immunology
- Retinal Pigment Epithelium/immunology
- Retinal Pigment Epithelium/microbiology
- Tuberculosis, Ocular/genetics
- Tuberculosis, Ocular/immunology
- Tuberculosis, Ocular/microbiology
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Affiliation(s)
- Soumyava Basu
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India; Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY, USA.
| | - Benjamin J Fowler
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY, USA
| | | | - Kristine B Arnvig
- Institute of Structural and Molecular Biology, University College, London, UK
| | - Narsing A Rao
- USC Eye Institute, The Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Aggarwal K, Agarwal A, Deokar A, Singh R, Bansal R, Sharma A, Sharma K, Dogra MR, Gupta V. Ultra-Wide Field Imaging in Paradoxical Worsening of Tubercular Multifocal Serpiginoid Choroiditis after the Initiation of Anti-Tubercular Therapy. Ocul Immunol Inflamm 2017; 27:365-370. [PMID: 29020501 DOI: 10.1080/09273948.2017.1373829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional choroiditis lesions, PW and altering the course of therapy in TB MSC.
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Affiliation(s)
- Kanika Aggarwal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Aniruddha Agarwal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ankit Deokar
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ramandeep Singh
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Reema Bansal
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Aman Sharma
- b Department of Internal Medicine , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Kusum Sharma
- c Department of Microbiology, Division of Mycobacteriology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Mangat R Dogra
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Vishali Gupta
- a Advanced Eye Center , Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Aggarwal K, Agarwal A, Sehgal S, Sharma S, Singh N, Sharma K, Samanta R, Invernizzi A, Sharma A, Gupta V. An unusual presentation of intraocular tuberculosis in a monocular patient: clinicopathological correlation. J Ophthalmic Inflamm Infect 2016; 6:46. [PMID: 27888495 PMCID: PMC5124017 DOI: 10.1186/s12348-016-0118-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022] Open
Abstract
Background Lack of uniform diagnostic criteria often poses a challenge in the diagnosis and management of tubercular uveitis. The index case describes an unusual presentation of tubercular panuveitis initially misdiagnosed as sympathetic ophthalmia, where the appropriate diagnosis was made using various imaging and laboratory investigations. Results A 52-year-old Indian woman underwent multimodal imaging, extensive clinical and laboratory work-up, and analysis of microbiological and histopathological specimens. At presentation, her best-corrected visual acuity (BCVA) was 20/30 in OD and no perception of light in OS. Ocular examination revealed multiple grayish-yellow choroiditis lesions resembling Dalen-Fuch’s nodules, vitritis, and disc edema. Diagnosis of sympathetic ophthalmia was made and patient treated with intravenous and oral corticosteroids and immunosuppressive therapy. After an initial favorable response, the lesions progressively increased with worsening of vitritis. Due to worsening of chorioretinal lesions which were atypical for sympathetic ophthalmia, further investigations were performed that revealed positive tuberculin skin test and contrast-enhanced computerized tomography chest showed calcified mediastinal lymph nodes. Enucleation of OS confirmed acid-fast bacilli on Ziehl-Neelsen staining, tubercular granulomas on histopathology, and positive polymerase chain reaction. Anti-tubercular therapy and oral steroids were started with good healing response. Conclusions Tubercular uveitis may have protean clinical manifestations. Thorough clinical evaluation and molecular/histopathological evaluation helps in establishing the diagnosis and the institution of appropriate therapy.
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Affiliation(s)
- Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Shobha Sehgal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suryaprakash Sharma
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Nirbhai Singh
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Kusum Sharma
- Department of Medical Microbiology, Division of Mycobacteriology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramanuj Samanta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Aman Sharma
- Department of Internal Medicine, Division of Rheumatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
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Singh R, Sharma K, Agarwal A, Dogra M, Gupta V, Sharma A, Dogra MR. Vanishing retinal arterial aneurysms with anti-tubercular treatment in a patient presenting with idiopathic retinal vasculitis, aneurysms, and neuroretinitis. J Ophthalmic Inflamm Infect 2016; 6:8. [PMID: 26922651 PMCID: PMC4769709 DOI: 10.1186/s12348-016-0074-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome presents with characteristic clinical manifestations such as aneurysms at arteriolar bifurcations and optic nerve and retinal vascular inflammation. Regression of such features on treatment with anti-tubercular therapy (ATT) combined with corticosteroids has not been reported in literature. Findings A 30-year-old female with sudden painless decreased vision in the left eye was referred with a diagnosis of presumed tuberculous retinal vasculitis and a positive tuberculin skin test. Based on the clinical and angiographic features of the right eye, a diagnosis of IRVAN syndrome was made. In the left eye, the patient had vitreous hemorrhage for which pars plana vitrectomy was performed. The vitreous sample was positive for Mycobacterium tuberculosis using multiplex polymerase chain reaction, and the patient was started on standard four-drug ATT and oral corticosteroids. At 6-month follow-up, vanishing of retinal arterial aneurysms was observed. Conclusions The pathogenesis of IRVAN syndrome is uncertain. One of the postulates is that the features of arterial aneurysms and other retinal vascular alterations occur secondary to acquired inflammatory reaction. We hypothesize that IRVAN syndrome may be a morphological diagnosis possibly associated with various entities, one of which could be ocular tuberculosis. It may be prudent to rule out intraocular tuberculosis in cases labeled as IRVAN syndrome in an endemic population.
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Affiliation(s)
- Ramandeep Singh
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohit Dogra
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Vishali Gupta
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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