Pitfalls in the management of TB-associated uveitis.
OBJECTIVE
The aim of this study is to highlight the pitfalls in the diagnosis and management of tuberculosis (TB)-associated uveitis.


METHODS
This is a retrospective review of case records of four patients with TB-associated uveitis.


RESULTS
In cases 1 and 2, failure to treat tubercular uveitis with anti-tubercular therapy (ATT) and unopposed steroid therapy led to a serious systemic consequence--development of intra-cranial tuberculoma. In case 4, similar failure to initiate ATT caused recurrent disease (focal choroiditis) in the eye. All four cases showed appearance of new lesions or worsening of existing lesions in the eye, following initiation of ATT. Such paradoxical reactions resolved by adding/increasing corticosteroid therapy.


CONCLUSIONS
TB-associated uveitis needs a strong index of suspicion for diagnosis and a combined anti-tubercular plus anti-inflammatory therapy for successful outcome.
Basu
S
S
Retina-Vitreous Services, LV Prasad Eye Institute, Bhubaneswar, India. basu@lvpei.org
Das
T
T
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000175:diagnosis / Q000188:drug therapy; D014392:Tuberculosis, Ocular / Q000175:diagnosis / Q000188:drug therapy; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents; D013256:Steroids; D011239:Prednisolone