The clinical cases of tuberculous panuveitis after dexamethasone intravitreal implants and paradoxical reaction to anti-Tb therapy
Purpose
To describe 3 clinical cases of Tb uveitis worsening after dexamethasone intravitreal implant and case of paradoxical response to anti-Tb therapy.
Methods
3 young patients referred to our clinic after previous treatment in other ophthalmologists. The previous diagnoses were idiopathic uveitis in 2 and toxo in 1 patient. They all previously got intravitreal dexamethasone implant few time ago with catastrophic worsening in 1 week after implantation.
Results
All patients had granulomatous panuveitis with large whitish-yellow chorioretinal granuloma. All had normal chest СT and negative QuantiFERON test. The diagnoses were made upon classical TB clinical picture and anamnesis. All patients were prescribed quadro anti-Tb therapy. 2 of them had slow positive dynamic, therapy lasted for about 1 year and large fibrous chorioretinal scars were formed. Another patient had initial positive dynamic but in a month her state worsened again. We regarded it as a phenomenon of "paradoxical reaction". Methylprednisolone 16 mg/day was added and tapered in 2 months. Inflammation significantly improved. Now she gets only anti-Tb therapy, only active chorioretinitis remains, anterior and intermediate are inactive.
Conclusion
Ophthalmologists should beware of dexamethasone intravitreal implants in any cases of unexplained ethiology of uveitis and especially in infectious suspicion. It’s important to remember about possible paradoxical reaction to the anti-Tb therapy to avoid mistakes in early treatment period.
Conflict of interest
No
Authors 1
Last name
ZBOROVSKA
Initials of first name(s)
O
Department
Uveitis department
City
Odesa
Country
Ukraine
Authors 2
Last name
Dorokhova
Initials of first name(s)
O
Department
Uveitis department
City
Odesa
Country
Ukraine
Authors 3
Last name
Horyanova
Initials of first name(s)
I
Department
Uveitis department
City
Odesa
Country
Ukraine
Authors 4
Last name
Kolesnichenko
Initials of first name(s)
V
Department
Uveitis department
City
Odesa
Country
Ukraine
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