Título / Title

ATYPICAL TUBERCULAR MULTIFOCAL RETINITIS IN A PATIENT TREATED WITH INTERFERON BETA-1A – A CASE REPORT

Introdução / Purpose

To report a clinical case of a 25-year-old patient presenting with unilateral posterior multifocal retinitis secondary to ocular tuberculosis after the initiation of interferon-beta 1-alpha due to multiple sclerosis.

Material e Método / Methods

Case report.

Resultados / Results

A 25-years-old female presented at the eye-related emergency department complaining of subacute loss of vision in the right eye, associated with floaters and photophobia. Her best-corrected visual acuity was 20/200 OD and 20/20 OS. The ophthalmic evaluation revealed mild conjunctival hyperemia, 2+ aqueous flare, and anterior vitreitis. The fundoscopic examination disclosed multiple retinitis foci across the posterior pole and mild periphery, with moderate to intense posterior vitreous opacifications. There were moderate optic disk hyperemia and no peripheral retinal vascular exudation. Her past medical history included multiple sclerosis and the initiation of interferon beta-1a injections about three months before the onset of symptoms. A comprehensive evaluation for multiple autoimmune and infectious systemic diseases yielded a positive tuberculin skin test with no other comorbidities. The diagnosis of unilateral multifocal retinitis secondary to tuberculosis reactivation was made, and a multi-drug anti-TB therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) was initiated in association with 40 mg/day oral prednisone. After two weeks, there was a significant improvement in the vitreitis and the retinitis, with complete regression of all retinal lesions in two months. Her visual acuity had restored to 20/20, and the anti-TB medications were discontinued after 9 months, with no recurrences behind one year of follow-up.

Discussão e Conclusões / Conclusion

The presented case highlights the importance of maintaining ophthalmologic surveillance in patients taking immunomodulatory medications. Atypical multifocal retinitis presentations, such as the one reported here, should also include tuberculosis as a differential diagnosis, especially in endemic countries.

Palavras Chave

Ocular tuberculosis, multifocal retinitis, posterior uveitis, interferon beta.

Area

CLINICAL RETINA