[Branch retinal vein occlusion in a 20-year-old patient]

Abstract

History: A 20-year-old patient from India was referred because visual acuity of the left eye had deteriorated four weeks ago. A left branch retinal vein occlusion (BRVO) had been diagnosed in an external eye clinic.

Investigations: His best corrected visual acuity was 1,0 in the right eye but only 0.3 in the left. Intraocular pressure was normal. Fundoscopy of the left eye confirmed the finding of a left BRVO. Fluorescein angiography showed evidence of a retinal vasculitis resulting in an ischemic BRVO. Full blood count showed leucocytosis. Chest X-ray, thoracic CT and an Interferon-Gamma Release Assay (IGRA) were suggestive of systemic tuberculosis (TB).

Treatment and course: Antituberculosis treatment with ethambutol, isoniazid, rifampicin and pyrazinamide was administered for 4 months followed by maintenace therapy of isoniazid and ethambutol for 6 months. 6 months after treatment visual acuity of the left eye had improved; the findings of lung TB had regressed.

Conclusion: BRVO associated with ocular TB is a rare presentation of retinal vasculitis. This rare manifestation of a BRVO emphasizes the need of thorough systemic evaluation in young patients with BRVO.