Disseminated Tubercular Granulomas Associated with the Use of Azathioprine

ABSTRACT

Purpose: To describe a case of multiple disseminated choroidal tuberculomas in a patient of early-phase Vogt-Koyanagi- Harada (VKH) disease being treated with Azathioprine.

Methods: A retrospective chart review.

Results: A 55-year-old female, a diagnosed case of VKH disease, was being treated with oral steroids and Azathioprine. During one of her follow-up visit, she was detected with multiple subretinal granulomas with surrounding fluid in both eyes. Fundus fluorescein angiography (FFA), Indocyanine green angiography (ICGA) and Optical Coherence Tomography (OCT) favored the presence of choroidal granulomas and Positron emission Tomography (PET) scan revealed lesions in spleen as well. She was started on anti-tubercular therapy along with oral steroids. She responded very well to treatment and her choroidal granulomas resolved in follow-up.

Conclusion: Disseminated tubercular granulomas can rarely occur with the use of oral Azathioprine and poses caution for its use in cases requiring long-term immunosuppressants.

KEYWORDS:

• Azathioprine
• disseminated tuberculosis
• tubercular granulomas
• Vogt-Koyanagi-Harada disease
• immunosuppression

Authors Contributions

All authors managed the patient. RS and PB wrote the report, and all authors approved the final draft. Consent to publish was obtained.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Summary

There have been reports of reactivation of the opportunistic infections with the use of immunosuppressants for example dissemination of mycobacterial infections. Here, the authors have reported a rare finding of choroidal and splenic granuloma with the use of tablet Azathioprine while the patient was being treated for VKH.