A 65-year-old Ecuadorian woman with no personal or family history of interest presented to the outpatient clinic due to painless decrease in vision in her right eye (OD) for 3 to 4 months.
The maximum visual acuity (VA) was 0.5 in the RE and 1.
Intrinsic motility was normal.
OD showed papilledema with some subretinal exudate.
CT and brain-orbital MRI, luetic serology, angiotensin converting enzyme, Lyme serology and chest X-ray were negative.
Systemic study by devices was not significant.
Mantoux (PPD), already in the first 24 hours, had an induration of 25 mm with areas of dermal necrosis.
The chest X-ray was repeated and the result was equally negative.
In CSF puncture the outflow pressure was 16 cm H2O with normal biochemistry and negative culture.
CSF electrophoresis did not detect oligoclonal bands.
Urocultiva and sputum culture were also negative for mycobacterium tuberculosis growth.
Suspicion of ocular tuberculosis was tested with 300 mg/day of isoniazid for 3 weeks with subjective improvement in vision of the RE although maximum vision remained 0.5.
He was treated with isoniazid 300 mg (9 months), rifampicin 600 mg (9 months), pyrazinamide 15 mg/kg (2 months) and etambuco 15 mg/kg (2 months).
One year after the first consultation the visual acuity of the RE was 0.9 and its normal examination.
