Pratibha Prasad et al JMSCR Volume 05 Issue 11 November 2017 Page 30094 JMSCR Vol||05||Issue||11||Page 30094-30097||November 2017 Case Report Concurrent Occurrence of Choroidal, Optochaismatic and Intracranial Tuberculomas: A Paradoxical Reaction of Anti Tubercular Drugs Authors Pratibha Prasad 1 , Vikas Kumar Gupta 2 , Amita Bhargava 3 , Khichar Shubhakaran 4 1 D.M. Neurology, Senior Resident, Department of Neurology , Dr. S.N. Medical College, Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India 2 M.D. Pathology, Department of Pathology, Institute of Medical Science, Banaras Hindu University, Varanasi – 221005, U.P. , India 3 D.M. Neurology, Professor and Head, Department of Neurology , Dr. S.N. Medical College , Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India 4 D.M. Neurology, Professor, Department of Neurology , Dr. S.N. Medical College , Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India Corresponding Author Pratibha Prasad D.M. Neurology, Senior Resident, Department of Neurology , Dr. S.N. Medical College , Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India Email: pratibhaprasad12@gmail.com Abstract Paradoxical response in CNS tuberculosis poses a diagnostic challenge in the management. We describe a 35 year-old immunocompetent female with documented tubercular meningitis with normal fundus and visual acuity without any history of tuberculosis and antitubercular drugs therapy (ATT),being treated with first line ATT, who 4 months later ,developed visual impairment in both eyes. Funduscopy showed the presence of a choroidal tuberculoma in her left eye. Brain MRIs revealed multiple tuberculomas intracranially and around the optic chaisma. ATT with addition of high dose steroid was continued. Following 2 years, she had no visual deficit. She was diagnosed with concurrent development of intracranial, optochaismatic and choroidal tuberculomas as a paradoxical reaction to ATT which is a rare occurrence and is yet not reported to our knowledge .Visual impairment developing in a patient on treatment with ATT should give rise to a suspicion of rare occurrence of optochiasmatic and choroidal tuberculomas thus preventing vision loss. Keywords: Choroidal , optochaismatic tuberculoma, intracranial tuberculoma, Introduction Paradoxical response has been defined as recurrence or appearance of fresh symptoms, physical and radiological signs in a patient who had previously shown improvement with appropriate antitubercular therapy (ATT). There is now need for greater understanding regarding the rare presentations, diagnosis and management of paradoxical response in CNS tuberculosis. www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i11.45