Jin-woo Kwon

Purpose: We are to report a case of presumedocular tuberculosis which showed retinal vasculitiswith intraretinal hemorrhagic cystic lesion which treated with anti-tuberculosis medication and surgical intervention.

Method: A 28-year-old man presented with suddenlydecreased vision in right eye for 1 week. His BCVA wasFC 50 cm in the right eye. Fundus in the right eyeshowed vitreous hemorrhage, multiple hemorrhagicretianl vasculitis with perivascular sheathing at inferiortemporal retinal vessel and intraretinal cyst containingblood fluid level. OCT showed that cystic lesion hadabout 5.50 mm × 4.81 mm sized at base and 7.03 mmhigh. Recently, he was in contact with his father whowas under treatment of anti tuberculosis treatment(ATT) due to pulmonary tuberculosis. In the Mantouxskin test was positive.

Result: The patient received ATT for the first 2months and systemic corticosteroids therapy for 1month. After treatment, fundus findings showedsubsided vitreal inflammation and vasculitis. TheOCT also showed decreased height of cyst. Butneovascularization around sustainted cystic lesionsand vitreous hemorrhage had occured at 3 months. Weperformed vitrectomy and drained fluid in theintraretinal cystic lesion. AFB stain, PCR assay andculture for tuberculosis from vitreous tap was all nega-tive. Postoperative fundus findings showed resolvedcystic lesion, vitritis and vitreous hemorrhage. But,OCT showed intraretinal tubercle.

Conclusion: Although tuberculosis is a treatabledisease, the consequences of delay in either ocular orsystemic diagnosis can be very serious for the patient.It is important to have a high index of suspicion oftuberculosis diagnosis.