Título

PARACENTRAL ACUTE MIDDLE MACULOPATHY AND CENTRAL RETINAL VEIN OCCLUSION AS COMPLICATIONS OF PULMONARY TUBERCULOSIS

Objetivo

To report a case of paracentral acute middle maculopathy (PAMM) and incipient central retinal vein occlusion as complications of pulmonar tuberculosis (TB).

Relato do Caso

15-year-old female presented with sudden reduction in visual acuity (VA) in the right eye (RE) for 15 days. She had been undergoing treatment for pulmonary TB for the previous 3 months, with positive rapid molecular test (RMT-TB) and mycobacterial culture in sputum. She started RIPE and RI 2 months later. Laboratory tests showed neutrophilic leucocytosis. Liquor examination, cerebral angiotomography, MRI and carotid and vertebral echocardiography were unremarkable. BCVA in the RE was 0.1 and in the LE was 1.0. Fundoscopy showed incipient venous occlusion, venous tortuosity in all quadrants, sparse hemorrhages, cotton-wool exudate in the upper temporal arcade and signs of previous arterial occlusion in the RE (Fig. 1). FA with no evidence of staining. OCT of the RE showed paracentral acute middle maculopathy (PAMM) (Fig. 2). After 3 months, the patient returned for a follow-up evaluation in which she had a VA of 0.5 in RE, with no other complaints.

Conclusão

Microvascular occlusion secondary to coagulation disorders caused by pulmonary TB can lead to serious ocular conditions. There are several theories for retinal vascular occlusion in TB. It is probable that the severe pulmonary TB infection induced an activation of inflammatory pathways that caused systemic hemostatic changes. Our case is interesting because the patient simultaneously presented both venous and arterial retinal ischemia, with incipient central vein occlusion and deep capillary plexus occlusion due the coagulation factors. Our patient did not have ocular involvement of TB but a complication of it. This case report highlights the importance for ophthalmologists to be alert to the possibility of retinal vascular occlusions in patients with TB, particularly in those with pulmonar involvement.