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correspondence

Indian Pediatr 2010;47: 896-897

Optic Neuritis and Anti tubercular Therapy


Syed Ahmed Zaki,

Department of Pediatrics, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai.
E-mail: [email protected] 
 


I read with interest the recent case report on bilateral optic neuritis due to isoniazid(1), and have the following comments to offer:

The patient described in the case was receiving both isoniazid and streptomycin. The visual side effects of isoniazid have been described in this report but those due to streptomycin have been overlooked. The visual complications described in literature during streptomycin therapy include slowness of accommodation, trembling of distant objects, continuance of image movement on turning the head, disturbance of color vision, papilledema and optic neuritis(2). Though uncommon, visual toxicity of streptomycin should have been kept as a differential diagnosis in their patient.

Paradoxical reactions are commonly seen during treatment of tuberculosis and steroids have been found to be useful in their treatment. Optic neuritis as a paradoxical reaction to tubercular allergen has been reported in adults(3). As the patient reported by them responded to corticosteroids, the visual loss attributed to isoniazid could be an immunologically mediated paradoxical reaction. I also encountered a case where the patient developed optic neuritis on anti-tubercular therapy; she was successfully managed with steroids, and isoniazid was continued.

Thus, the patient described in this case report had a clinical adverse event (optic neuritis) which in addition to isoniazid therapy, could also be explained by concurrent disease (paradoxical reaction) or the other drug (streptomycin). Taking into consideration the above factors, the Naranjo algorithm for adverse drug reaction causality assessment yields a score of 4 (and not 6 as per authors), suggesting that the adverse drug reaction was only possibly (and not probably) related to isoniazid.

References

1. Kulkarni HS, Keskar VS, Bavdekar SB, Gabhale Y. Bilateral optic neuritis due to isoniazid (INH). Indian Pediatr 2010; 47: 533-535.

2. Walker GF. Blindness during streptomycin and chloramphenicol therapy. Br J Ophthalmol 1961; 45: 555-559.

3. Monga PK, Dhaliwal U. Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation. Indian J Ophthalmol 2009; 57: 139-141.
 

 

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