Peer-reviewed article
57 Ocular tuberculosis: a differential for chronic panuveitis
Thakkar M, Migowa A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical case report describing a 9-year-old boy diagnosed with ocular tuberculosis presenting with chronic panuveitis. The document discusses the clinical presentation, diagnostic methods including interferon-gamma release assay, and treatment with anti-inflammatory and anti-tuberculosis medications. While it mentions a child patient, the focus is on clinical diagnosis and management of a rare eye disease rather than child well-being outcomes.
Key points
- A 9-year-old male presented with a red, painless left eye and deteriorating vision caused by ocular tuberculosis
- Diagnosis was confirmed using interferon-gamma release assay (IGRA), which was positive, alongside negative tests for other causes
- Treatment included methotrexate, prednisone, and topical steroids with marked clinical improvement
- Ocular TB can manifest through various eye structures and may cause irreversible blindness
- Non-ocular tests such as IGRA and tuberculin tests are useful diagnostic tools when direct ocular fluid culture carries high risk
Limitations
This is a single case report with no comparison group or outcome data, so it cannot establish the efficacy of treatments or generalize findings to other children. The document focuses on clinical diagnosis and management rather than measuring child well-being outcomes or health impacts.
Abstract
Abstract Background Mycobacterium tuberculosis is an organism responsible for causing chronic granulomatous inflammation leading to active or latent tuberculosis (TB). Both pulmonary and extrapulmonary infections; including the skin, the eye, the cardiovascular, genitourinary and gastrointestinal systems can occur. Within the eye, it can cause global disease ranging from anterior or posterior uveitis to retinal TB. Within this abstract we demonstrate a case of chronic panuveitis with a diagnosis of ocular TB. Methodology Retrospective chart review Results We reviewed a 9-year-old- male in the rheumatology outpatient clinic who was on treatment for ocular TB with methotrexate 2.5 mg once a week, prednisone 5 mg once a day, maxitrol eye drops once a day and prednisolone eye drops twice a day. He presented with a red, painless left eye with deteriorating vision 2 years ago. Functional enquiry was unremarkable. He was noted to have a fixed dilated left pupil at 3-4mm but other examinations were normal. Extensive investigations were carried out, including an Interferon-gamma release assay (IGRA)- which was positive. Toxoplasma antibody test, Treponema pallidum Haemagglutination test, and chest X-ray were all negative. He was then started on the above-mentioned therapies with marked improvement. A decision on increasing the methotrexate dose if steroid tapering showed no improvement was undertaken and a plan on reassessing the patient with ANA, ACE and HLA B51 was made, to ensure complete workup. Discussion and conclusion Intra or extra ocular TB (OTB) manifestations may result as a direct inoculation of the organism in ocular fluid or as a systemic immune response initiated by an infection from a distant site. There is a myriad of ocular manifestations of OTB which make forming a clinical diagnostic criterion difficult. The gold standard for diagnosis is an ocular fluid culture showing organisms but the yield may be low and the risk of damage to surrounding structures may be high. PCR tests done on the sample may yield clinical information but non ocular tests, such as the IGRA and tuberculin tests may also be employed. Therapy depends on active vs latent disease and mainly involves anti-inflammatory agents and anti-TBs. Ocular TB may lead to sudden and irreversible blindness with high socioeconomic implications and hence, an index of suspicion in areas with a high disease burden should be kept as diagnosis poses a challenge.