Case Study: Resolving Diagnostic Uncertainties in the Clinical Presentation of Ocular Tuberculosis

Case Study: Resolving Diagnostic Uncertainties in the Clinical Presentation of Ocular Tuberculosis

Swarna Biseria Gupta (Department of Ophthalmology, L.N. Medical College, Bhopal, India), Divya Verma (Department of Ophthalmology, L.N. Medical College, Bhopal, India) and D. P. Singh (Department of Ophthalmology, L.N. Medical College, Bhopal, India)
Copyright: © 2014 |Pages: 8
DOI: 10.4018/ijudh.2014070106
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Abstract

In the developing countries, incidence of systemic tuberculosis is very high, with over 8 million new cases each year. The incidence of tuberculous uveitis is also rising correspondingly. It is difficult to diagnose ocular tuberculosis because of the lack of specific ocular findings and specific confirmatory laboratory tests. However, in a developing country like India, where the prevalence of latent tuberculosis is high, uveitis of unexplained cause not fitting into known uveitis entities, in presence of Monteux positivity, is more likely to be tubercular in origin. Hence, early diagnosis and prompt treatment with antitubercular treatment may result in dramatic drop in recurrence and improve individual patient outcomes.
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Case No. 1

A 62 year-old female patient reported to our hospital in January 2012, complaining of blurring of vision and floaters in left eye for 2 months. There were recurrent episodes of the same complaints in the past; the visual acuity in her left eye was 6/9 and that in her right eye was6/6. Anterior segments were normal. Fundus examination revealed patches of active choroiditis disseminated all over the fundus of left eye. On fundus fluorscein angiography hypofluoroscence with late staining was seen. Mantoux was strongly positive (16mm) along with lymphocytosis. Intravenous Methyl prednisolone 1 gm was given for 3 days along with four drugs anti-tubercular treatment (Rifampicin 600mg, INH 300mg, Ethambutol 800mg, Pyrazinamide 1500mg) in addition to maintenance systemic steroids in tapering doses. Lesions healed completely in four weeks. There had been no recurrence even after 2years after completion of treatment.

Figure 1.

Fundus photograph of left eye, showing active lesion of choroiditis in upper nasal quadrant

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