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Neurological rarities
Bilateral optic neuritis as a first presentation of lymph node tuberculosis
  1. Ashvini Keshavan1,2,
  2. Lisa McAnena3,
  3. James F Acheson3,
  4. Helen Booth4,5,
  5. Gordon T Plant2,
  6. Zhaleh Khaleeli2,6
  1. 1 Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
  2. 2 Department of Neuro-ophthalmology, National Hospital for Neurology and Neurosurgery, London, UK
  3. 3 Department of Neuro-ophthalmology, Moorfields Eye Hospital City Road Campus, London, UK
  4. 4 North Central London Tuberculosis Service, Whittington Health NHS Trust, London, UK
  5. 5 Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  6. 6 Department of Neuroinflammation, National Hospital fro Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Ashvini Keshavan, Dementia Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; a.keshavan{at}ucl.ac.uk

Abstract

Tuberculosis (TB) may affect the nervous system in many ways. We describe an immunocompetent teenage girl with lymph node TB who had first presented with bilateral optic neuritis. Detailed history identified features inconsistent with immune-mediated optic neuritis. Several unusual features prompted further investigation, including transient visual obscurations without raised intracranial pressure, prominent disc swelling and absence of laboratory findings to support an immune-mediated cause. Whole body PET/MR imaging identified widespread mediastinal and supraclavicular lymphadenopathy. Despite no known TB contacts, a negative interferon gamma release assay and a normal chest X-ray, a targeted lymph node biopsy confirmed TB.

  • neuroophthalmology
  • tuberculosis
  • vision
  • ophthalmology

https://doi.org/10.1136/practneurol-2021-003086

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    Footnotes

    • Twitter @AshviniKeshavan

    • Contributors AK, GTP and ZK conceptualised the study. LM and JFA acquired and analysed clinical data. AK performed the literature review, acquired and analysed clinical data, and drafted the manuscript. All other authors revised the manuscript critically for important intellectual content. All authors gave final approval of the submitted manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Unrelated to this work, AK receives research funding from the Selfridges Foundation (Weston Brain Institute Grant UB170045).

    • Provenance and peer review Not commissioned: externally reviewed by Luke Bennetto, Bristol, UK.