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KMID : 0882420120820050642
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Korean Journal of Medicine
2012 Volume.82 No. 5 p.642 ~ p.646
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A Case of Tuberculous Optochiasmatic Arachnoiditis
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Park So-Eun
Kim Ji-Beom
Kang Bo-Hyoung
An Ji-Hyun
Kim You-Jae
Lim Hyun-Taek
Kim Sung-Han
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Abstract
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Tuberculous optochiasmatic arachnoiditis (OCA) is a rare complication of tuberculous meningitis. We describe a 47-year-old female with tuberculous OCA confused with ethambutol-associated optic neuropathy. She was on anti-tuberculous treatment (i.e., isoniazid, rifampin, ethambutol, and pyrazinamide) for two months due to tuberculous meningitis. Visual impairment occurred during treatment, and ethambutol was changed to levofloxacin because of concern for ethambutol-associated optic neuropathy. Her visual impairment did not improve three months after anti-tuberculous treatment that excluded ethambutol, and she was referred to our hospital. Brain MRI showed enhancement of the optic chiasm and bilateral optic tract, and fundoscopy revealed bilateral optic nerve atrophy, suggesting tuberculous OCA. Her visual acuity was partially improved after anti-tuberculous treatment. Tuberculous OCA should be considered in addition to ethambutol-associated optic neuropathy for a patient with tuberculous meningitis who presents with visual impairment.
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KEYWORD
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Arachnoiditis, Ethambutol, Impaired vision, Optic chiasm, Tuberculous meningitis
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