A healthy 27-year-old Caucasian male presented with progressive blurred vision in the right eye (OD) (Table 1). He denied ocular pain, headaches, and other ocular or systemic symptoms. Best corrected visual acuity (BCVA) was 10/10 in both eyes. Anterior segment evaluation showed low-grade iridocyclitis in the OD. Dilated ocular fundus examination revealed moderate vitritis, optic disc edema, vascular tortuosity, and venous vasculitis with perivascular hemorrhages mainly in the nasal quadrants of the OD (Figure 1). Fluorescein angiography showed severe venous vasculitis with important retinal ischemia in the correspondent quadrants of the same eye (Figure 1 and Table 1). Unilateral panuveitis with retinal vasculitis, prompted for the search of an etiology study while topical therapy with prednisolone and bromofenac, was implemented.
Initial investigation included hemogram, platelet count, hepatic and renal function, erythrocyte sedimentation rate, human leukocyte antigen (HLA) B51, antinuclear antibody, lysozyme, angiotensin-converting enzyme (ACE), and infectious serologic analysis. No suspicious lesions indicating active tuberculosis or sarcoidosis were found in the computed tomography (CT) of the thorax; although, it showed a cisural micronodule with a 4 mm ganglion (Table 1). A further systematic review was unremarkable. Tuberculin skin sensitive test and IGRA test (5.59) were positive, and Eales' disease was considered the likely diagnosis.
Besides topical therapy, corticoid therapy (1 mg/Kg/day oral prednisolone) with slow progressive withdrawal was started, associated with quadruple antituberculosis therapy (ethambutol, rifampicin, pyrazinamide and isoniazid). Oral methotrexate (15 mg/week) was introduced two months later, keeping slow progressive corticosteroids withdrawal with clinical improvement (Table 1). Sectorial laser photocoagulation of the ischemic nasal quadrants of the retina was performed after vasculitis remission (Figure 1).
Two years after diagnosis, having completed one year of antitubercular and two years of immunosuppressive treatment, the patient remains clinically stable, with no signs of active vasculitis and no need for further therapy.