Case report: atypical presentation of Mycobacterium tuberculosis uveitis preceding nodular scleritis.
BACKGROUND
Intraocular tuberculosis is uncommon and has various clinical presentations. Lack of specific clinical clues can make the diagnosis challenging. The purpose of this study is to report a clinical presentation of tuberculous iridocyclitis that mimics phacolytic glaucoma and has a distinctive inflammatory deposit in the inner side of the cornea. This report is the first to describe the progression of tuberculous iridocyclitis to nodular scleritis without evidence for extraocular tuberculous infection.


METHODS
A 78-year-old, immunocompetent woman presented with subacute intraocular inflammation with high intraocular pressure, mimicking phacolytic glaucoma. Distinct pigment keratic precipitates were noted on the first visit. Even though the cataract extraction was uneventful and adequate anti-inflammatory drugs were given, the inflammation did not subside as expected. Seven weeks later, she developed two scleral abscesses, which were subsequently explored for microbiological investigation. The smears of the pus revealed positive acid-fast bacilli stain and PCR for Mycobacterium tuberculosis complex. Eventually, the pus culture grew Mycobacterium tuberculosis. Anti-tuberculosis medications were prescribed. After 1 month of treatment, the abscesses were cured. However, her visual acuity did not improve at the last visit.


CONCLUSIONS
This case revealed an unusual presentation and untreated course of tuberculosis iridocyclitis. Pattern of keratic precipitates may indicate the presence of tuberculosis.
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand. bae_sunnee@yahoo.co.uk.
Sunee
S
Chansangpetch
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand. animanassa@gmail.com.
Anita
A
Manassakorn
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand. prasarteye@yahoo.co.th.
Prasart
P
Laksanaphuk
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand. usaneer@gmail.com.
Usanee
U
Reinprayoon
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D002387:Cataract Extraction / Q000009:adverse effects; D005260:Female; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000472:pathogenicity*; D016133:Polymerase Chain Reaction; D015423:Scleritis / Q000188:drug therapy / Q000209:etiology*; D014392:Tuberculosis, Ocular / Q000188:drug therapy / Q000382:microbiology*; D014605:Uveitis / Q000188:drug therapy / Q000382:microbiology*; D014792:Visual Acuity
D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents