Abstract
Tuberculous optochiasmatic arachnoiditis (OCA) is a rare complication of tuberculous meningitis. We describe a 47-year-old female with tuberculous OCA confused with ethambutol-associated optic neuropathy. She was on anti-tuberculous treatment (i.e., isoniazid, rifampin, ethambutol, and pyrazinamide) for two months due to tuberculous meningitis. Visual impairment occurred during treatment, and ethambutol was changed to levofloxacin because of concern for ethambutol-associated optic neuropathy. Her visual impairment did not improve three months after anti-tuberculous treatment that excluded ethambutol, and she was referred to our hospital. Brain MRI showed enhancement of the optic chiasm and bilateral optic tract, and fundoscopy revealed bilateral optic nerve atrophy, suggesting tuberculous OCA. Her visual acuity was partially improved after anti-tuberculous treatment. Tuberculous OCA should be considered in addition to ethambutol-associated optic neuropathy for a patient with tuberculous meningitis who presents with visual impairment.
결핵성 시신경교차 거미막염은 결핵성 수막염의 드문 합병증으로 심각한 시각 장애를 유발할 수 있으나, 항결핵제를 사용하고 있는 도중에도 발생할 수 있고, 항결핵제에 의한 안독성 증상과 혼돈될 수 있다. 저자들은 에탐부톨 독성에 의한 시각 장애로 오인되었던 결핵성 시신경교차 거미막염을 경험하였으므로 결핵성 수막염으로 항결핵제 치료를 받고 있는 환자에서 시각 장애 증상을 보일 경우, 결핵성 시신경교차 거미막염의 가능성을 고려하여 뇌 자기공명영상 및 안과적 검사를 적극적으로 시행을 고려해야 할 것으로 생각한다.