OPTIC PERINEURITIS DUE TO TUBERCULOSIS WITH NO PULMONARY DISEASE: A report of two cases and MRI findings

• DOI: 10.22533/at.ed.1593712308098

• Palavras-chave: Perineurite óptica; Tuberuclose; Perda Visual; Ressonância Magnética; Jovem do sexo feminip.

• Keywords: Optic Perineuritis; Tuberculosis; Visual Loss; Magnetic Resonance Imaging; Young Female;

• Abstract: Optic perineuritis (OPN) is a rare form of orbital inflammatory disorder, which occurs on the optic nerve sheath and adjacent tissue. It may be idiopathic, also known as primary, or secondary to underlying causes, such as infections or autoimmune diseases. Patients usually present with progressive visual loss and pain during eye movements which can be uni or bilateral. Clinically, optic perineuritis may be similar and difficult to distinguish from optic neuritis, resulting in delayed diagnosis and treatment. Magnetic Resonance Imaging (MRI) plays a fundamental role in the diagnosis of this condition, with perineural enhancement representing the utmost imaging biomarker. Tuberculosis (TB) is essentially a lung disease caused by Mycobacterium tuberculosis. Extrapulmonary disease may occur alone or in association with pulmonary TB. Ocular involvement is uncommon, occurring in less than 5% of cases (3).  Herein we report two cases of young female patients presenting progressive visual loss, with the final diagnosis of optic perineuritis due to tuberculosis with no pulmonary disease, in which the diagnosis was based on imaging findings and cerebrospinal fluid (CSF) analysis. We reinforce the importance of identifying this disorder in early stage, for appropriate management and a better prognosis.