Loss of vision and renal function in a patient with miliary tuberculosis.

INTRODUCTION

Visual loss is a rare complication of tuberculosis; it can be related to anti-tuberculous drugs or to the infection itself. For the treatment of visual loss, differential diagnosis is important between infection and adverse effect of anti-tuberculous drugs.

CASE: A 48-year-old male patient with a history of tuberculosis and visual loss during anti-tuberculous drug therapy was admitted to our hospital. Anti-tuberculous drugs had been stopped on the 2nd day of therapy due to development of optic neuritis secondary to ethambutol administration at another hospital. He had miliary tuberculosis, renal failure requiring dialysis and visual disturbances. Anti-tuberculous drugs, including ethambutol, were initiated at our clinic because the period between the ethambutol therapy and visual loss was too short and the dose of ethambutol was not very high. Computed brain tomography was normal. Fundoscopic examination revealed only hypertensive retinopathy. Our diagnosis was tuberculosis-related visual loss, which could be due to neuroretinitis, intraocular tuberculosis or chiasmal tuberculoma. In addition, ethambutol rarely causes visual loss during the early period or when given at lower doses. In our case no complications developed from the treatment and the patient's visual loss and renal function improved. At his last visit, 12 months later, his vision had improved and his serum creatinine was lower, at 2.2 mg/dL.

CONCLUSION

With anti-tuberculous treatment, renal functions and visual disturbances were improved in a patient with miliary tuberculosis. During the anti-tuberculous therapy, visual loss can be related to ethambutol toxicity or the tuberculosis infection itself. Differential diagnosis is very important and anti-tuberculous drugs must be continued if the diagnosis is tuberculosis.