A Case of Wegener's Granulomatosis Misdiagnosed as Ocular Tuberculosis.

Kim, Ho Chang; Oh, Tschang Seog; Chang, Sung Dong

Case Report

Journal of the Korean Ophthalmological Society 2003;44(5):1223-1229.
Published online May 1, 2003.

A Case of Wegener's Granulomatosis Misdiagnosed as Ocular Tuberculosis.

Ho Chang Kim, Tschang Seog Oh, Sung Dong Chang

Department of Ophthalmology, Dongguk University College of Medicine, Korea. Changsd@dongguk.md

눈결핵으로 오인된 Wegener 육아종증 1예

김호창 ( Ho Chang Kim ) , 오창석 ( Tschang Seog Oh ) , 장성동 ( Sung Dong Chang )

Abstract

PURPOSE
To report a case of Wegener's granulomatosis misdiagnosed as ocular tuberculosis. METHODS: A 65-year-old man who was treated with anti-tuberculosis medications as suspected pulmonary tuberculosis was referred from the department of internal medicine for visual loss over months. His initial visual acuity was counting fingers at 30 cm in the right eye and there was a chorioretinal scar involving the macula on fundus examination. At that time, we thought that the lesion was a tuberculosis-related chorioretinal scar and so he was treated with anti-tuberculosis medications. There was a recurrent bilateral anterior uveitis during three months from the initial visit. RESULTS: After 14 months, he was examined by otorhinolaryngologist due to a saddle nose deformity and Wegener's granulomatosis was diagnosed based on positive Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and nasal mucosal biopsy. At that time, ocular examination revealed the necrotizing scleritis in both eyes and orbital CT showed bony destruction of medial and inferior orbital wall without proptosis in both eyes. We had treated with oral cyclophosphamide and prednisone. CONCLUSIONS: We experienced a case of Wegener's granulomatosis with chorioretinal scar misdiagnosed as ocular tuberculosis. In conclusion, we should differentially diagnose Wegener's granulomatosis from suspected ocular tuberculosis.

Key Words: Chorioretinal scar;Ocular tuberculosis;Wegener's granulomatosis