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Case Report/Case Series
November 2013

Paradoxical Growth of Presumed Optochiasmatic Tuberculomas Following Medical Therapy

Author Affiliations
  • 1Department of Ophthalmology, St John’s Medical College, Bangalore, India
  • 2Department of Neurology, St John’s Medical College, Bangalore, India
JAMA Ophthalmol. 2013;131(11):1463-1467. doi:10.1001/jamaophthalmol.2013.4840

Importance  Tuberculosis is an endemic infectious disease in developing countries. Patients receiving treatment for systemic tuberculosis may develop paradoxical growth of tuberculomas in the brain, which can lead to vision loss.

Observations  We describe 3 patients who had paradoxical development of tuberculomas in the anterior optic pathway during treatment for tuberculosis and presented with acute vision loss. These optochiasmatic tuberculomas were not present at the initial presentation of tuberculosis and appeared on brain magnetic resonance imaging at the time of presentation with vision loss. Vision improved on instituting systemic corticosteroids in addition to antituberculous treatment.

Conclusions and Relevance  As there was visual recovery after patients began receiving systemic corticosteroids and there was no worsening of the systemic condition, it is reasonable to assume that the optochiasmatic tuberculomas resulted from a paradoxical reaction. It is important to recognize this condition and initiate prompt treatment to reduce visual morbidity.

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