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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 60  |  Issue : 2  |  Page : 200-202

Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report


Department of Ophthalmology, Lokmanya Tilak Municipal Medical College and General Hospital, Maharashtra, India

Date of Submission11-Nov-2021
Date of Decision16-May-2022
Date of Acceptance20-May-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Sanyukta Joshi
Flat 201, Chandravijay society, Mahatma Phule Road, Opposite Deshmukh Garden, Mulund East, Mumbai - 400 081, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_170_21

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  Abstract 


Pigmented paravenous chorioretinal atrophy (PPCRA) refers to unilateral or bilateral pigmentation along retinal veins with changes on fundus autofluorescence and electroretinography (ERG). PPCRA cases have usually been noted as sporadic and its association with tuberculosis has rarely been demonstrated. Here, we report a case of PPCRA in a young female with tuberculosis and fundus autofluorescence and ERG findings suggestive of macula involving bilateral PPCRA. This case demonstrates the presence of PPCRA in a patient with active tuberculosis and importance of considering PPCRA as a diagnosis in patients of tuberculosis with mild diminution of vision.

Keywords: Case report, chorioretinal atrophy, retinopathy, tuberculosis


How to cite this article:
Joshi S, Trivedi M, Shinde C. Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report. TNOA J Ophthalmic Sci Res 2022;60:200-2

How to cite this URL:
Joshi S, Trivedi M, Shinde C. Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Oct 7];60:200-2. Available from: https://www.tnoajosr.com/text.asp?2022/60/2/200/349514




  Presentation and Clinical Findings Top


A 15-year-old female patient reported gradual diminution of vision in both eyes since a few years. She had tuberculous cervical lymphadenopathy and was under Category 1 anti-tubercular therapy since 1.5 months (Intensive therapy of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol for 2 months followed by Continuation therapy of isoniazid and rifampicin for 4 months). Best corrected visual acuity of both eyes was 6/9 N6. Fundus evaluation revealed bilateral bone spicule pigmentation and retinochoroidal atrophy of pigment epithelium along vascular arcades [Figure 1]a.
Figure 1: (a) Fundus photo shows bone spicule pigmentation along veins OS. (b) FAF shows paravenous hypofluorescence with surrounding hyperfluorescence. (c): Pattern ERG shows reduced amplitude of N35, P50 and N95 indicating macular involvement. (d): Dark adaptation ERG shows decreased amplitude of b-wave

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Fundus autoflurorescence revealed hypofluorescence along paravenous areas with surrounding hyperfluorescence [Figure 1]b. Pattern electroretinography (ERG) showed decreased amplitudes of N35, P50 and N95 indicating early macular involvement [Figure 1]c and dark adapted ERG showed decreased amplitude of b-wave [Figure 1]d.

Based on the clinical picture and the electrophysiological findings, a diagnosis of bilateral pigmented paravenous chorioretinal atrophy (PPCRA) with macular involvement was made.


  Discussion Top


Brown reported a case of PPCRA in 1937 and called it retinochoroiditis radiata.[1] It is characterised by unilateral or bilateral pigmentation along the retinal veins.[1] Majority of cases are sporadic, though mutations of CRB1 (crumbs homolog-1) gene, Behcet's disease and other causes of inflammation have been implicated.[2] Disease is asymptomatic and diagnosed incidentally on fundus examination.[3] Association between this disease and tuberculosis has not been adequately demonstrated.[1]

FAF shows hypofluorescence surrounded by hyperfluorescence along retinal veins.[4]

Dark adapted ERG may shows diminution of b-wave.[5]

No specific treatment is available.[3] This photo essay highlights presence of PPCRA in a patient with active tuberculosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brown TH. Retino-Choroiditis Radiata. Br J Ophthalmol 1937;21:645-8.  Back to cited text no. 1
    
2.
McKay GJ, Clarke S, Davis JA, Simpson DAC, Silvestri G. Pigmented paravenous chorioretinal atrophy is associated with a mutation within the crumbs homolog 1 (CRB1) gene. Invest Ophthalmol Vis Sci 2005;46:322-8.  Back to cited text no. 2
    
3.
Deshmukh S, Das D, Deka H, Bhattacharjee H, Upadhyay A, Gupta K. Pigmented paravenous retinochoroidal atrophy. Indian J Ophthalmol 2019;67:271-3.  Back to cited text no. 3
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4.
Hashimoto Y, Kase S, Saito W, Ishida S. Abnormalities of fundus autofluorescence in pigmented paravenous chorioretinal atrophy. Open Ophthalmol J 2012;6:125-8.  Back to cited text no. 4
    
5.
Pearlman JT, Kamin DF, Kopelow SM, Saxton J. Pigmented paravenous retinochorodial atrophy. Am J Ophthalmol 1975;80:630-5.  Back to cited text no. 5
    


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