Título

OPTIC PERINEURITIS ASSOCIATED WITH MULTIDRUG RESISTANT TUBERCULOSIS IN AN IMMUNOCOMPETENT PATIENT.

Objetivo

To report a case of optic perineuritis associated with multidrug resistant tuberculosis in an immunocompetent patient

Relato do Caso

A 22-year-old female presented at an emergency care unity in a small-scale hospital in Southern Brazil with a history of 8-months evolution of cough, weight loss, night sweats and headache. She took no medications continuously and medical history was unremarkable. Chest CT showed multiple lung nodular opacities randomly distributed and cavitation on the right inferior pulmonary lobe. Rifampicin-resistant Tuberculosis (TB) was confirmed as diagnosis after two bronchoalveolar lavage. The patient tested negative for immunodeficiencies. Treatment according to national guidelines was started. One week after hospital admission, the patient noticed limitations of movement, followed by acute loss of sight, ptosis and ocular pain in the left eye (OS). Symptoms were initially noted in OS, but later were observed on both eyes. After the onset of ophthalmological symptoms, she was transferred to a tertiary care hospital. Corrected visual acuity was 0.8 in the right eye (OD) and 0.05 in OS. There was no afferent pupillary defect, though pupillary reflex was diminished in OS. Anterior segment findings included slight anterior chamber reaction (0,5+) and flare (1+) in OS. IOP was normal. Fundoscopy showed optic disc edema in OS (Figure 2). Brain magnetic resonance imaging (MRI) showed a bilateral thickening of the sheath of the intraorbital segments of the optic nerve with blurring of perineural fat tissue (Figure 1). A diagnosis of perineuritis secondary to active pulmonary tuberculosis was made. Oral prednisolone 1 mg/kg/day was started and kept for 4 months. After 6 months, best corrected visual acuity is 1.0 in OD and 0.8 in OS , with complete resolution of extraocular movement and no optic disc edema.

Conclusão

This case reinforces the importance of considering tuberculosis as a rare differential diagnosis of optic perineuritis even in young patients and the need for early treatment seeking to preserve vision and reduce morbidity.