Tuberculous Uveitis Presenting with a Bullous Exudative Retinal Detachment: A Case Report and Systematic Literature Review

Comparison of uveitis manifestations in patients with active systemic tuberculosis and those with positive interferon-gamma release assay without active disease

OBJECTIVE

To evaluate the clinical manifestations of uveitis in patients with active systemic tuberculosis (TB) and compare them to those with uveitis of undetermined cause who were positive for the interferon-gamma release assay (IGRA) but did not have active systemic TB.

METHODS

This retrospective study included 118 patients: 51 with uveitis and active systemic TB, 52 with undetermined cause of uveitis and positive IGRA but no active systemic TB, and 15 with positive Mycobacterium tuberculosis (Mtb) polymerase chain reaction (PCR) results from ocular fluids but no active systemic TB. Demographic data, ocular findings, and systemic TB investigations were analysed and compared.

RESULTS

Patients with evidence of active TB were predominantly younger. Typical manifestations of ocular TB (OTB) were more frequently observed in patients with active systemic TB (p < 0.001) and were significantly associated with younger age (p = 0.002). In patients without active systemic TB but positive Mtb PCR from ocular fluid, ocular manifestations closely resembled those of patients with active systemic TB, particularly with respect to the presence of choroidal granulomas. In contrast, patients with an undetermined cause of uveitis who tested positive for IGRA were older, and their clinical features were more often atypical.

CONCLUSIONS

Uveitis associated with active systemic TB was characterised by typical OTB manifestations and occurred more frequently in younger patients. These findings highlight the importance of considering TB in the differential diagnosis of uveitis, especially in younger individuals, and suggest that atypical manifestations may be more common in older patients and in patients without active TB.

Tuberculous ciliary body granuloma initially diagnosed as bullous retinal detachment: a case report

BACKGROUND

Ocular tuberculosis is a relatively rare extrapulmonary manifestation of tuberculosis. This vision-threatening disease is extremely challenging to diagnose, particularly because it can mimic other diseases. We report a case of tuberculous ciliary body granuloma initially diagnosed as bullous retinal detachment.

CASE REPORT

A 52-year-old female presented with bullous retinal detachment in her left eye, and ultrasound biomicroscopy (UBM) verified the presence of a lesion with ciliary body granulomatous inflammation. The T-SPOT was positive, and the purified protein derivative (PPD) test was strongly positive (diameter of 20 mm). Following the administration of oral anti-tuberculosis regimen combined with prednisone, the retina gradually became reattached, the ciliary body granuloma became significantly reduced in size, and the visual acuity of the patient noticeably improved.

CONCLUSIONS

Tuberculous ciliary body granulomas can cause bullous exudative retinal detachment and can be diagnosed with UBM. Early and full-course anti-tuberculosis treatment (ATT) combined with corticosteroid therapy can improve the patient prognosis.

Disseminated tuberculosis involving the eye, skin, axillary lymph nodes and lungs in an immunocompetent host

A female in her early 40s presented to the outpatient clinic for weight loss, fatigue, cough, followed by a gradual painful loss of vision in the right eye associated with redness over the past 3 months. Physical examination revealed bilateral axillary lymphadenopathy and non-healing skin ulcers on the left forearm and the left gluteal region. The patient had no light perception in the right eye and grade 4+ cells in the anterior chamber. A chest X-ray showed a cavitary lesion in the left upper lobe. Histopathological tests from the skin and lymph nodes revealed caseating granulomas, raising the suspicion of tuberculosis. A sputum nucleic acid amplification test was performed, which returned positive for Mycobacterium tuberculosis The patient was treated with antitubercular chemotherapy and showed encouraging signs of progress after the treatment.

Clinical features and long-term treatment outcomes in choroidal tuberculoma

PURPOSE

To investigate the clinical features and treatment outcomes of patients with choroidal tuberculoma.

METHODS

In this retrospective, observational case series, the medical records of five patients with choroidal tuberculoma who were followed up at a university hospital for at least 6 months were analyzed.

RESULTS

Of five patients, one was male and four were female. The overall mean age was 38.0 ± 9.4 years (mean follow-up: 41.2 ± 33.8 months). Tuberculin skin test was performed in three patients, and it was positive in two of them. Interferon-gamma assay was performed in two patients and was positive in all two. Three patients had systemic tuberculosis involving the lung or other organs. Five patients were treated with antitubercular therapy for a period of 9.6 ± 8.6 months. Systemic corticosteroid treatment was performed in 3 patients, with a period of 3.5 ± 0.7 months. One patient with a recurrent vascularized tuberculoma was successfully treated with single intravitreal bevacizumab injection.

CONCLUSION

Choroidal tuberculoma can develop without evidence of systemic tuberculosis and can recur despite antitubercular treatment. High index of suspicion is important in early detection, and management of choroidal tuberculoma. In cases of suspected choroidal tuberculoma, positive results on immunological tests would be sufficient to initiate antitubercular therapy even if radiological evidence of systemic tuberculosis is not found. Antitubercular therapy combined with systemic corticosteroids provided favorable results. Intravitreal injection of anti-vascular endothelial growth factor may be considered for highly vascularized choroidal tuberculoma.