Case study of Tubercular Retinal Vasculitis

Case presentation A 20-year-old African American male initially presented with complaints of blurry vision in the right eye more than the left eye. He noticed some floaters but denied any other visual symptoms including eye pain and he denied full systemic review of systems as well. At the outside ophthalmologist, he was diagnosed with uveitis and was treated with a sub-tenon’s Kenalog injection to both eyes and was started on topical Durezol and acyclovir orally. However, he did not improve significantly so he was referred to the LVP clinic for further evaluation. Past medical history Asthma, but not on any medication. No H/o ocular history or surgery. Accepted recreational marijuana use but denied any other tobacco, alcohol, or significant recreational drug use. Grandmother had glaucoma. No recent travel history and did. Have cats and dogs at his home. Eye examination Visual acuity: 20/70 in the right eye 20/50 in the left eye Pressures, pupils, and extraocular movements were within normal limits. No eyelid lesions Conjunctiva – Not injected Corneal lens – Clear Iris – Round without any synechiae or lesions Dilated fundus examination: Showed some old vitreous cell in both eyes and was seen in the Optos fundus photos of both eyes. He had a significant perivascular sheathing, which was worse in the left eye. The fundus autofluorescence of the right eye shows a little bit of faint hypo-autofluorescence along the temporal vasculature and the left eye showed some subtle hypo-autofluorescence round lesions along the vasculature. Optical coherence tomography (OCT) macula test: Right eye: Showed some thinning of the temporal retina with an epiretinal membrane and showed a hyper-reflective RPE lesion looking at the fovea. Left eye: Showed multiple RPE lesions including one hyper-reflective lesion at the fovea. Indocyanine Green Angiography (ICG): ICG angiography was done and a significant subtle…

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