Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Dimitrios Kalogeropoulos, George Kitsos, Athanasios Konstantinidis, Constantina Gartzonika, Evgenia Svarna, Konstantinos Malamos, Emmanouil Katsanevakis, Chris Kalogeropoulos
(Department of Ophthalmology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece)
Am J Case Rep 2017; 18:367-374
Ocular tuberculosis (TB) is a clinical entity that presents with a wide range of clinical manifestations. It is regarded as an extremely challenging condition from the point of view of diagnostic approach and calls for early diagnosis and prompt treatment, as it can potentially lead to blindness.
CASE REPORT: This is a case report of a 32-year-old male from southern India who has been living and working in Greece over the last 10 years and presented with 2-week history of pain and progressive visual impairment of his left eye. He underwent a thorough clinical ophthalmological examination and imaging of the fundus, and the findings were consistent with uveitis. However, the manifestations of the inflammation were complicated as they included features that could be attributed mainly to Vogt-Koyanagi-Harada (VKH) disease and tuberculous serpiginous-like uveitis. Therefore, a systemic evaluation, together with specific laboratory and paraclinical investigations, were carried out to define the etiology of the inflammation and develop an optimal therapeutic plan. Taking into account specific findings from the chest imaging, a positive purified protein derivative (PPD) skin test, and sputum cultures positive for Mycobacterium tuberculosis (MTB), we set a diagnosis of posterior sclero-uveitis and started our patient on anti-tuberculous treatment.
CONCLUSIONS: This case reveals an atypical manifestation of tuberculous sclero-uveitis imitating Vogt-Koyanagi-Harada disease together with a few characteristics of serpiginous-like tuberculous uveitis, emphasizing the fact that tuberculosis should always be included in the differential diagnosis of uveitis when there is no obvious underlying disease.
Keywords: Antibiotics, Antitubercular, Follow-Up Studies, latent tuberculosis, Mycobacterium tuberculosis, Tuberculosis, Ocular, Uveitis, Posterior