Dr. Priyanka, P17413, Dr. Jyotirmay Biswas
A 37-year male presented with dimness of vision in left eye for 15 days with 6/9, N8 BCVA. Fundus showed active choroidal lesion threatening macula. FFA revealed early hypo and late hyper fluorescence lesion showing activity. Diagnosis of Tubercular serpiginous like choroiditis was made based on positive Mantoux and QTB test with HRCT chest findings. He received 3 doses of IVMP & started on ATT with Prednisolone 60 mg/day with weekly tapering. At 1-month fundus showed active lesion. Prednisolone increased to 60mg/day. At 2 month left eye fundus showed healing lesion but right eye developed active lesions. Azathioprine added. Both eye fundus at 3 months showed healing lesion and at 5 months healed lesion with BCVA 6/6, N6.
Conclusion: It is important to aware of paradoxical worsening, so that one doesn’t interrupt ATT. It generally resolves on escalation of corticosteroid therapy and/or addition of immunosuppression. Cases not responding to immunosuppression need to be re-investigated.