title: [Vasoproliferative tumor associated with presumed ocular tuberculosis: case report].
abstract: OBJECTIVE
  To describe a case of vasoproliferative tumor associated with presumed ocular tuberculosis treated with cryotherapy and intravitreal triamcinolone injection.
  
  
  METHODS
  Interventional case report. A 42-year-old female patient reported inflammation of the right eye 1 year ago, treated with oral prednisone for 30 days. She referred blurred vision in the right eye since childhood. Ophthalmologic examination showed 20/400 visual acuity in the right eye. Biomicroscopy and intraocular pressure were normal. Fundus examination showed vascularized elevated lesion, associated with serous retinal detachment and hard exudates at the inferior periphery. The lesion was surrounded by extensive area of hyperplastic retinal pigment epithelium. The macula showed attenuation of the foveal reflex. Ocular ultrasound showed a 2.25 mm height vascularized lesion. Serologic examination, hemogram and thorax RX were normal. PPD was considered strong reactor and tuberculosis was diagnosed after positive BK research. Considering the clinical aspects, the ocular diagnosis was vasoproliferative tumor associated with presumed ocular tuberculosis. Treatment with rifampicin, isoniazide and pyridoxine was started. We decided to treat the ocular tumor with cryotherapy and intravitreal triamcinolone injection (4 mg/ml). After 30 days, serous detachment was smaller and the tumor showed atrophic areas. Fluorescein angiography showed areas of vascular hyperfluorescence with slight extravasation and areas of blocked fluorescence due to RPE hyperplasia. Secondary vasoproliferative tumors are retinal glial proliferations and are associated with many ocular conditions that affect retina and choroid. Because of the great number of associated complications, with important visual loss, vasoproliferative tumors should be treated at the moment of diagnosis. Treatment of choice is cryotherapy. Intravitreal triamcinolone can be used as adjuvant treatment because of its angiogenic properties. Until the present moment, no ocular tuberculosis and vasoproliferative tumor association were reported in the literature. Treatment of secondary vasoproliferative tumors with cryoterapy and intravitreal triamcinolone appears as a new therapeutic choice. Further studies are necessary to prove the efficacy of this association.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luciana Duarte
authors.initials: LD
authors.lastname: Rodrigues
authors.forename: Luciana Lucci
authors.initials: LL
authors.lastname: Serracarbassa
authors.forename: Haley
authors.initials: H
authors.lastname: Rosa
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Pedro Durães
authors.initials: PD
authors.lastname: Serracarbassa
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D017679:Cryotherapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006391:Hemangioma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014221:Triamcinolone / Q000627:therapeutic use; D014392:Tuberculosis, Ocular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D005938:Glucocorticoids; D014221:Triamcinolone