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Case Reports
. 2022 Aug 2;14(8):e27600.
doi: 10.7759/cureus.27600. eCollection 2022 Aug.

Bilateral Optic Perineuritis in Tuberculosis-Immune Reconstitution Inflammatory Syndrome

Ismail Fatimah-Halwani  1 , Zulaikha Wahab  1 , Nurul Ain Masnon  1 , Wan-Hazabbah Wan Hitam  1 , Ismail Shatriah  1 , Juhara Haron  2
Affiliations
Case Reports

Bilateral Optic Perineuritis in Tuberculosis-Immune Reconstitution Inflammatory Syndrome

Ismail Fatimah-Halwani et al. Cureus. .

Abstract

Optic perineuritis (OPN) in pulmonary tuberculosis (PTB) patients while on anti-tuberculous treatment is rare. It may occur due to tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS). Visual prognosis is poor if not treated early. We report a rare case of bilateral OPN in an elderly patient on treatment for PTB. A 79-year-old Malay man presented with a painless bilateral blurring of vision for three weeks. He was diagnosed to have PTB and has been on anti-tuberculous treatment for five months. Visual acuity in both eyes was only counting fingers. Optic nerve function tests were significantly reduced bilaterally. Fundoscopy showed bilateral segmental temporal optic disc pallor. Both visual field assessments were constricted. Other infective screenings and tumor markers were negative. Neuro-imaging revealed bilateral OPN involving the intraorbital segment. High-dose intravenous corticosteroid therapy was commenced, followed by slow tapering of oral prednisolone. Anti-tuberculous treatment was continued for a total course of nine months. The left visual acuity improved to 3/60. However, the right eye vision remained poor. His general condition was good.

Keywords: corticosteroids; idiopathic orbital inflammatory disease; immune reconstitution inflammatory syndrome; optic perineuritis; tuberculosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Temporal disc pallor in both eyes.
Figure 2
Figure 2. (Left) Axial view of gadolinium fat suppression T1-weighted MR image showed enhancement of bilateral optic nerve sheath “tram track sign” and (right) coronal view of gadolinium fat suppression T1-weighted MR image showed enhancement of bilateral optic nerve sheath “doughnut sign” at the intraorbital segment of optic nerve.
Figure 3
Figure 3. OCT RNFL at four-month follow up showed marked thinning of right RNFL.
See this image and copyright information in PMC

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