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Int Ophthalmol (2014) 34:675677 DOI 10.1007/s10792-013-9848-x
CASE REPORT
Isolated ocular Jarisch2Herxheimer reaction after initiating tuberculostatic therapy in a child
Henrike Neunhffer Annika Gold Hans Hoerauf
Carl Herbort Arnd Heiligenhaus Ortrud Zimmermann
Nicolas Feltgen
Received: 28 July 2013 / Accepted: 17 August 2013 / Published online: 11 September 2013 Springer Science+Business Media Dordrecht 2013
Abstract After being exposed to a kindergarten teacher with infectious pulmonary tuberculosis, a 7-year-old girl with a positive tuberculin skin test was treated with isoniazid. 3 days after initiation of the tuberculostatic therapy, the girl was referred to our hospital with an acute onset of blurred vision. Visual acuity (VA) was 20/200 in both eyes. Examination revealed mild anterior chamber inammation, optic disc swelling, cystoid macular edema and periphlebitis in both eyes. However, although active tuberculosis was ruled out, the interferon-gamma release assay was positive. The anti-tuberculosis therapy was intensied with pyrazinamide, isoniazid, rifampicin and
methylprednisolone. Within 10 days we saw a resolution of the macular edema and VA was 20/25. The paradoxical worsening of the patients condition after initiation of tuberculostatic therapy with isoniazid and the prompt response to systemic steroids are typical for Jarisch-Herxheimer reaction (JHR). Our patient presented no symptoms before the isoniazid therapy was started and the reaction was ocular without any generalized symptoms. This is unique among all other reported cases of ocular JHR.
Keywords Intraocular JarischHerxheimer reaction (JHR) Latent tuberculosis infection
Isoniazid ATT Paradoxical worsening
Introduction
We describe a case of an isolated ocular Jarish-Herxheimer reaction (JHR) after tuberculostatic therapy with isoniazid in a child.
Case
After being exposed to a kindergarten teacher with infectious pulmonary tuberculosis, a 7-year-old healthy girls post-exposure tuberculin skin test (Mantoux) was positive, although she presented no pulmonary or extrapulmonary symptoms. Treatment with oral isoniazid 150 mg once per day was initiated.
H. Neunhffer (&) H. Hoerauf N. Feltgen
University Eye Hospital, Robert-Koch-Str. 40, 37075 Gttingen, Germanye-mail: [email protected]; [email protected]
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