Maurice F. Rabb » Vasculitis With Neovascularization

This 30 year old Mexican male noted decreased vision in his right eye three days prior to admission on March 6, 1975. There were no other ocular symptoms of note. On review of systems, he admitted to a 30 pound weight loss during the previous year despite good appetite. Except for a small amount of white phlegm, there were no other symptoms or medical history of note.

OCULAR EXAMINATION
Vision: RE: 20/40.
LE: 20/15.

Significant finding were limited to the fundus examination. The right retina revealed dilated veins with vascular sheathing. Intra-, pre-retinal, and vitreous hemorrhages were associated with neovascularization. The marked constriction and obliteratin of the peripheral vessels suggested the picture of "Eale's disease". In the left eye, there was venous sheathing, occasional exudates, and retinal hemorrhage.

HOSPITAL COURSE:
After admission to the hospital, medical evaluation was obtained. Diabetes and other more common causes of neovascularization were ruled out. On the basis of a markedly positive skin test, chest x-rays were obtained and compatible with tuberculosis. The sputum was shown to be markedly positive Mycobacterium tuberculosis by smear and culture.

On this basis, the patient was treated intensively with anti-tuberculous medication and without steroids. Subsequently, the vitreous hemorrhage resolved. In addition to resolution of the pulmonary infiltrates, his retinal vasculitis has resolved such that there is no longer the sheathing or signs of inflammation previously noted. The areas of vascular obliteration remain unchanged. The areas of neovascularization, likewise, remain unchanged.

While it cannot be proven that tuberculosis is causative and may well be just an association, it is of interest that this is a case of vasculitis with neovascularization in which tuberculosis has been diagnosed. On anti-tuberculous treatment without steroids, the signs of phlebitis and vascular inflammation have resolved. The vitreous hemorrhage has resolved for the most part and the neovascularization has remained unchanged. These processes would not be expected to respond any differently regardless of the etiology for the neovascularization.