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Ocular tuberculosis-diagnostic difficulties and therapeutic features

Nicoleta Anton, Ciprian Danielescu*, Laura Popa, Anisia Iuliana Alexa, Alina Cantemir, Camelia Margareta Bogdanici, Roxana Elena Ciuntu

Intraocular Tuberculosis is a Granulomatous Chronic Infection with Mycobacterium tuberculosis with or without systemic involvement. It is a challenge to put a correct diagnosis and to establish a specific therapeutic protocol. We present the case of a patient with a history of Pulmonary Tuberculosis, with ocular signs and symptoms suggesting Intraocular Tuberculosis, a rare form of extra Pulmonary Tuberculosis. The chief complaints of the patient were: progressive loss of vision in the left eye for about 5 days, night sweating, oral ulcerations. Taking into account the infectious context, we requested a pneumologic consult. The thoracic X-ray was normal, the sputum examination was negative for M. tuberculosis and QuantiFERON: positive. Before initiating the therapy, we made an anterior chamber paracentesis for aqueous bacteriology test. Under anti-tuberculosis drugs and systemic steroids the visual acuity got better, we observed also a full recovery of visual field defects and the disappearance of retinal changes. Intraocular Tuberculosis is difficult to diagnose and, in general, it is a diagnosis of exclusion. Most of the patients with Ocular Tuberculosis don't have systemic manifestations. A delay in the diagnosis and treatment could lead to permanent loss of vision.