Tubercular Harada disease – An unreported uveitic entity

INTRODUCTION: & IMPORTANCE: Ocular tuberculosis and Vogt Koyanagi Harada disease (VKHD) both are the important cause of panuveitis. In tubercular endemic region like Nepal, latent tuberculosis (TB) may be accompanied with the features of VKHD. Hence, the aim of our publication is the use the term Tubercular Harada disease (THD) for such panuveitis with mixed features. CASE PRESENTATION: We aim to report two cases of panuveitis from Nepal with the simultaneous features of tuberculous uveitis and Harada disease managed with combined antitubercular agents and antimetabolites. CLINICAL DISCUSSION: Two cases presented with bilateral decreased vision with no systemic associations. They had bilateral panuveitis and sunset glow. Ultrasonography showed the choroidal thickening, optical coherence tomography confirmed macular edema with retinal nerve fibre layer edema. Electroretinogram of both eyes showed reduced P1 wave amplitude. All the systemic investigations were normal except the positive tuberculin skin test and TB QuantiFERON Gold test. Both of them were managed with intravenous/oral corticosteroid (1mg/kg) along with CAT- I ATT regimen (2HRZE+7HR) for 9 months and oral antimetabolites (azathioprine or methotrexate). Long term follow-up showed normal visual acuity with no evidence of recurrence of uveitis. CONCLUSION: Mycobacterium could have triggered the onset of Harada disease in TB endemic country like Nepal leading to simultaneous presentation of Tubercular Harada Disease.