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Choroidal tuberculoma with membranous glomerulonephritis
1Department of Nephrology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, #162 Ilsan-dong, Wonju, 220-701, Korea.
Yonsei Medical Journal
|August 24, 2001
Summary
High-dose steroid therapy for membranous glomerulonephritis (MGN) in a young man triggered miliary tuberculosis and a choroidal tuberculoma. Treatment with anti-tuberculosis drugs resolved the infection and reduced the ocular mass.
Area of Science:
- Ophthalmology
- Nephrology
- Infectious Diseases
Background:
- Membranous glomerulonephritis (MGN) is a leading cause of nephrotic syndrome in adults.
- Corticosteroid therapy is a common treatment for MGN, but carries risks of infection.
- Tuberculosis (TB) reactivation is a known complication of immunosuppressive therapy.
Observation:
- A 24-year-old male with MGN developed nephrotic syndrome, initially treated with corticosteroids.
- After 34 months, relapse of edema prompted high-dose steroid therapy, leading to miliary tuberculosis and a solitary choroidal tuberculoma.
- The patient presented with generalized edema, proteinuria, and later, ocular and pulmonary lesions.
Findings:
- Renal biopsy confirmed membranous glomerulonephritis (MGN).
- Miliary tuberculosis and a solitary choroidal tuberculoma developed during high-dose corticosteroid treatment for MGN.
- Anti-tuberculosis chemotherapy led to resolution of pulmonary symptoms and regression of the choroidal mass.
Implications:
- This case highlights the risk of opportunistic infections, specifically tuberculosis, in patients with MGN undergoing immunosuppressive therapy.
- Ocular manifestations like choroidal tuberculoma can be a sign of disseminated tuberculosis in immunocompromised individuals.
- Prompt diagnosis and treatment of tuberculosis are crucial for managing these complications and improving patient outcomes.