An isolated presentation of ischemic retinal vasculitis by the great masquerader mycobacterium tuberculosis with literature review

• Main Authors: Lim, Yi Wen, Lott, Pooi Wah, Mohamad, Nor Fadhilah, Samsudin, Amir, Singh, Sujaya, Iqbal, Tajunisah Begam Mohamed
• Format: Article
• Published: Lippincott Williams & Wilkins 2021
• Subjects: R Medicine; RC Internal medicine; RC306-320.5 Tuberculosis; RE Ophthalmology; Ophthalmology
• Online Access: http://eprints.um.edu.my/34812/

Ischemic retinal vasculitis is a sight-threatening inflammatory ocular condition that involves the retinal blood vessels. It is often associated with vascular occlusion and retinal hypoperfusion that may lead to neovascularization and subsequently preretinal and vitreous hemorrhages. It can be idiopathic or secondary to infection, neoplasia, or any other systemic diseases. Although it is rare, tuberculosis, which is an airborne disease caused by Mycobacterium tuberculosis, can manifest as retinal vasculitis without any evidence of pulmonary or other ocular structures involvement. We present a case of a 16-year-old girl with sudden blurred vision in the right eye. Based on fundoscopic examination and fluorescein fundus angiography, the right eye had severe bilateral ischemic vasculitis and neovascularization. Both Mantoux and tuberculosis spot test (T-Spot) further supported the presumptive clinical diagnosis of ocular tuberculous ischemic retinal vasculitis. Subsequently, pan-retinal photocoagulation sessions were commenced together with antituberculosis therapy and resulted in improved vision. We also include a literature review of similar reported cases where occlusive retinal vasculitis is the only presentation of ocular tuberculosis. Although this case highlights the possibility of ischemic retinal vasculitis as the only feature of ocular tuberculosis, a high degree of suspicion is necessary when dealing with this great masquerader.