To describe the case of a patient with Crohn's disease who was treated with Infliximab and Azathioprine and developed multisystemic tuberculosis, along with a resistant choroidal tuberculoma that occurred as a result of an immune reconstitution inflammatory syndrome.
Methods
A 20-year-old patient with Crohn's disease treated with Infliximab and Azathioprine subsequently developed multisystemic tuberculosis, including miliary tuberculosis of the lungs, spleen and liver. The diagnosis was confirmed through a lymph node biopsy that tested positive for Mycobacterium tuberculosis. The patient was admitted to the hospital for anti-tuberculous quadritherapy and oral steroids after Infliximab and Azathioprine were discontinued. While hospitalised, the patient reported rapid vision loss in the right eye. Fundus photographs and fluorescein angiography revealed a large choroidal tuberculoma near the right optic nerve, reducing the patient's vision to no light perception. Although the patient's general state improved, the tuberculoma increased in size and the patient's vision remained the same.
Results
No antibiotic resistance was found, and the patient's blood tests showed decreased lymphocytes, leading to a diagnosis of immune reconstitution inflammatory syndrome. The patient's dose of oral steroids was increased to 1mg per kg per day, resulting in a slow reduction in the size of the tuberculoma, although the patient did not recover his vision.
Conclusion
Choroidal tuberculoma is a rare condition resulting from the hematogenous spread of Mycobacterium tuberculosis. Latent tuberculosis should be screened for in patients requiring anti-TNF alpha treatment. The IRIS syndrome occurs after a rapid resolution of immunosuppression and may cause severe ocular inflammation.
Conflict of interest
No
Authors 1
Last name
VASSENEIX
Initials of first name(s)
C
Department
Ophthalmology
City
Lyon
Country
France
Authors 2
Last name
SERRAR
Initials of first name(s)
Y
Department
Ophthalmology
City
Lyon
Country
France
Authors 3
Last name
REZKALLAH
Initials of first name(s)
A
Department
Ophthalmology
City
Lyon
Country
France
Authors 4
Last name
MATHIS
Initials of first name(s)
T
Department
Ophthalmology
City
Lyon
Country
France
Authors 5
Last name
KODJIKIAN
Initials of first name(s)
L
Department
Ophthalmology
City
Lyon
Country
France
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