|Year : 2022 | Volume
| Issue : 2 | Page : 200-202
Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report
Sanyukta Joshi, Mihir Trivedi, Chhaya Shinde
Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Maharashtra, India
|Date of Submission||11-Nov-2021|
|Date of Decision||16-May-2022|
|Date of Acceptance||20-May-2022|
|Date of Web Publication||30-Jun-2022|
Flat 201, Chandravijay society, Mahatma Phule Road, Opposite Deshmukh Garden, Mulund East, Mumbai - 400 081, Maharashtra
Source of Support: None, Conflict of Interest: None
Pigmented paravenous chorioretinal atrophy (PPCRA) refers to unilateral or bilateral pigmentation along retinal veins with changes on fundus autofluorescence and electroretinography (ERG). PPCRA cases have usually been noted as sporadic and its association with tuberculosis has rarely been demonstrated. Here, we report a case of PPCRA in a young female with tuberculosis and fundus autofluorescence and ERG findings suggestive of macula involving bilateral PPCRA. This case demonstrates the presence of PPCRA in a patient with active tuberculosis and importance of considering PPCRA as a diagnosis in patients of tuberculosis with mild diminution of vision.
Keywords: Case report, chorioretinal atrophy, retinopathy, tuberculosis
|How to cite this article:|
Joshi S, Trivedi M, Shinde C. Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report. TNOA J Ophthalmic Sci Res 2022;60:200-2
|How to cite this URL:|
Joshi S, Trivedi M, Shinde C. Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Aug 12];60:200-2. Available from: https://www.tnoajosr.com/text.asp?2022/60/2/200/349514
| Presentation and Clinical Findings|| |
A 15-year-old female patient reported gradual diminution of vision in both eyes since a few years. She had tuberculous cervical lymphadenopathy and was under Category 1 anti-tubercular therapy since 1.5 months (Intensive therapy of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol for 2 months followed by Continuation therapy of isoniazid and rifampicin for 4 months). Best corrected visual acuity of both eyes was 6/9 N6. Fundus evaluation revealed bilateral bone spicule pigmentation and retinochoroidal atrophy of pigment epithelium along vascular arcades [Figure 1]a.
|Figure 1: (a) Fundus photo shows bone spicule pigmentation along veins OS. (b) FAF shows paravenous hypofluorescence with surrounding hyperfluorescence. (c): Pattern ERG shows reduced amplitude of N35, P50 and N95 indicating macular involvement. (d): Dark adaptation ERG shows decreased amplitude of b-wave|
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Fundus autoflurorescence revealed hypofluorescence along paravenous areas with surrounding hyperfluorescence [Figure 1]b. Pattern electroretinography (ERG) showed decreased amplitudes of N35, P50 and N95 indicating early macular involvement [Figure 1]c and dark adapted ERG showed decreased amplitude of b-wave [Figure 1]d.
Based on the clinical picture and the electrophysiological findings, a diagnosis of bilateral pigmented paravenous chorioretinal atrophy (PPCRA) with macular involvement was made.
| Discussion|| |
Brown reported a case of PPCRA in 1937 and called it retinochoroiditis radiata. It is characterised by unilateral or bilateral pigmentation along the retinal veins. Majority of cases are sporadic, though mutations of CRB1 (crumbs homolog-1) gene, Behcet's disease and other causes of inflammation have been implicated. Disease is asymptomatic and diagnosed incidentally on fundus examination. Association between this disease and tuberculosis has not been adequately demonstrated.
FAF shows hypofluorescence surrounded by hyperfluorescence along retinal veins.
Dark adapted ERG may shows diminution of b-wave.
No specific treatment is available. This photo essay highlights presence of PPCRA in a patient with active tuberculosis.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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Deshmukh S, Das D, Deka H, Bhattacharjee H, Upadhyay A, Gupta K. Pigmented paravenous retinochoroidal atrophy. Indian J Ophthalmol 2019;67:271-3.
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