rifampin and Optic-Atrophy

A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Brucella abortus; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Ophthalmoplegia; Optic Atrophy; Papilledema; Rifampin; Streptomycin

A 56-year old patient presented 3 months after initiation of an antituberculous regimen with Isoniacid (INH, 5 mg/kg daily), Ethambutol (20 mg/kg daily) and Rifampicin (675 mg daily) a mild sensory polyneuropathy and a bilateral retrobulbar neuritis which progressed to a severe optic atrophy. Multiple hyperintense foci were detected with NMR-imaging in the cerebral white matter suggestive of demyelination. INH and Ethambutol are known for their neurotoxic effects but suggestion was made that neurologic signs may not be due to drug neurotoxicity but could be induced by immunological processes initiated by the tubercle bacillus. In the reported patient the suspected tuberculosis of the urogenital tract was never proved histologically. Most likely his neurological symptoms were therefore cause by the administration of INH and Ethambutol. Patients with a low serum zinc level and a slow acetylation of INH are reported to be at special risk; both factors were present in our patient.

Topics: Antitubercular Agents; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Optic Atrophy; Peripheral Nervous System Diseases; Rifampin

Topics: Aged; Capreomycin; Electroretinography; Ethambutol; Humans; Male; Optic Atrophy; Optic Neuritis; Rifampin; Scotoma; Time Factors; Tuberculosis, Pulmonary; Visual Fields; Vitamin B Complex