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TitelVogt Koyanagi Harada disease complicated by tuberculosis reactivation and occlusive vasculitis in a young man: about a challenging case.
DoelThis case emphazises the need to bear in mind and rule out an alternative infectious diagnosis in the presence of posterior uveitis showing unexpected progression.
MethodesSingle case report
ResultatenWe report the case of a Moroccan seventeen year old man presenting with bilateral visual loss, panuveitis, exudative retinal detachments and diffuse choroidal infiltration. The patient also complained of headaches and ear pain. Based on the fundus, fluoangiography, ICG and OCT, the diagnosis of Vogt Koyagani Harada disease was made. He received high dose methylprednisolone along with azathioprine. We observed good response to treatment with progressive visual improvement, vanishing of sub retinal fluid and lowering of tyndall and vitritis. One month after initiating treatment, the right eye presented a sectorial retinal vasculitis with infero temporal vein branch occlusion and massive sub retinal hemorrhages. The coagulation screening as well as HIV and syphilis serology were negative but quantiferon was positive. A Pet scan revealed hypermetabolic mediastinal lymph nodes and a biopsy confirmed tuberculosis infection. An anti-TB quadritherapy was initiated, leading to an enzymatic induction, a lower steroid treatment efficacy and finally a choroidal inflammation recurrence.
ConclusieIn this case, the immunosuppressive treatment led to tuberculosis reactivation and we observed some retinal vasculitis probably related to the infectious disease. It illustrates the challenging treatment management in case of longstanding inflammatory eye disease and tuberculosis reactivation.
BelangenverstrengelingNee
Auteur 1
NaamBOUTERFA
InitialenZ
InstituutCliniques universitaires saint-luc
Stadbruxelles
Auteur 2
NaamKozyreff
InitialenA
InstituutCliniques universitaires saint-luc
StadBruxelles
Auteur 3
NaamYildiz
InitialenH
InstituutCliniques universitaires saint-luc
StadBruxelles
Auteur 4
NaamYombi
InitialenJ
InstituutCliniques universitaires saint-luc
StadBruxelles
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