title: Paradoxical growth of presumed optochiasmatic tuberculomas following medical therapy.
abstract: OBJECTIVE
  Tuberculosis is an endemic infectious disease in developing countries. Patients receiving treatment for systemic tuberculosis may develop paradoxical growth of tuberculomas in the brain, which can lead to vision loss.
  
  
  METHODS
  We describe 3 patients who had paradoxical development of tuberculomas in the anterior optic pathway during treatment for tuberculosis and presented with acute vision loss. These optochiasmatic tuberculomas were not present at the initial presentation of tuberculosis and appeared on brain magnetic resonance imaging at the time of presentation with vision loss. Vision improved on instituting systemic corticosteroids in addition to antituberculous treatment.
  
  
  CONCLUSIONS
  As there was visual recovery after patients began receiving systemic corticosteroids and there was no worsening of the systemic condition, it is reasonable to assume that the optochiasmatic tuberculomas resulted from a paradoxical reaction. It is important to recognize this condition and initiate prompt treatment to reduce visual morbidity.
authors.affiliation: Department of Ophthalmology, St John's Medical College, Bangalore, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Joseph
authors.forename: Teena M
authors.initials: TM
authors.lastname: Mendonca
authors.forename: Usha
authors.initials: U
authors.lastname: Vasu
authors.forename: Suneetha
authors.initials: S
authors.lastname: Nithyanandam
authors.forename: Thomas
authors.initials: T
authors.lastname: Mathew
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001766:Blindness; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009897:Optic Chiasm / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000473:pathology*; D016862:Tuberculoma, Intracranial / Q000473:pathology*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity; D014794:Visual Fields; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D005938:Glucocorticoids