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Tuberculosis, or TB, is a bacterial infectious disease caused by Mycobacterium tuberculosis. While its primary impact is on the lungs, leading to pulmonary tuberculosis, it can also affect various other organs, a condition referred to as extrapulmonary tuberculosis.
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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Tuberculosis, more commonly referred to as TB, is an infectious disease stemming from Mycobacterium tuberculosis. While it primarily impacts the lungs, TB can also affect other body areas. Given its severity and global impact, timely and accurate diagnosis is crucial for controlling its spread and improving patient outcomes.
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Tuberculous optochiasmatic arachnoiditis.

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Central nervous system tuberculosis can paradoxically worsen during treatment, leading to severe complications like optochiasmatic arachnoiditis. Managing these paradoxical reactions and associated vision loss remains a significant clinical challenge.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Central nervous system tuberculosis (CNS TB) requires prolonged treatment.
  • Paradoxical reactions, including worsening inflammation, can occur during antituberculous therapy.
  • Optochiasmatic arachnoiditis is a rare but severe complication affecting vision.

Purpose of the Study:

  • To describe a case of severe optochiasmatic arachnoiditis in a patient with CNS TB.
  • To discuss the challenges in managing paradoxical reactions to antituberculous therapy.
  • To review treatment strategies for optochiasmatic arachnoiditis.

Main Methods:

  • Case report of a 24-year-old woman with recurrent CNS TB.
  • Detailed description of clinical course, diagnostic findings, and treatment interventions.
  • Review of literature on paradoxical reactions and optochiasmatic arachnoiditis management.

Main Results:

  • The patient developed multiple cerebral tuberculomas and optochiasmatic arachnoiditis during antituberculous therapy.
  • Treatment with corticosteroids, second-line antituberculous drugs, infliximab, and thalidomide showed initial partial improvement.
  • Despite escalating treatment, visual deficits progressed, and the patient ultimately died from sepsis.

Conclusions:

  • Optochiasmatic arachnoiditis poses a significant risk of irreversible blindness in CNS TB patients.
  • Optimal treatment strategies for paradoxical reactions and optochiasmatic arachnoiditis are not well-established.
  • Further research is needed to guide the management of these complex conditions.