| A five-year-old boy presented with tuberculous meningitis and subsequently developed amaurosis with optochiasmatic arachnoiditis (OCA) late in the convalescent stage of the illness. The visual evoked cortical potentials were correlated with the decreased and improved postoperative acuity. The diagnosis and classification of OCA have been discussed with emphasis given to prompt neurosurgical treatment. ( info) |
2/88. Nasolacrimal tuberculosis in a patient with conjunctivodacryocystorhinostomy. PURPOSE: To present an unusual case of nasolacrimal tuberculosis that was diagnosed with polymerase chain reaction (PCR) and to discuss the role of PCR as a diagnostic aid. methods: Case presentation with diagnostic modalities including PCR, cytopathologic, and histopathologic examinations with special stains. RESULTS: A 40-year-old woman with bilateral lacrimal drainage system obstruction underwent a right dacryocystorhinostomy with stents and left conjunctivodacryocystorhinostomy with Jones bypass tube. Although the findings of direct and endoscopic examinations of the nasal cavity were within normal limits, the tissue removed during surgery from the middle turbinate revealed caseating granulomatous lesions on histopathologic examination. Acid-fast organisms were demonstrated in postoperative nasal washings, and mycobacterium tuberculosis infection was confirmed with PCR. CONCLUSION: Primary tuberculosis of the nasolacrimal mucosa is rare, and its occurrence without any symptoms, as in this patient, is even less frequent. The most interesting aspect of this case was the identification of the M. tuberculosis dna in the mucosa of anterior turbinate and fibrous tissue within the previous surgical site. Histopathologically, the presence of caseating granulomas was seen only in the nasal mucosa, indicating that PCR may be of use in identifying the causative organism even in the absence of typical histopathologic features. ( info) |
3/88. Tuberculous neuroretinitis. OBJECTIVES: To describe a patient with tuberculous neuroretinitis. MATERIALS AND methods: Retrospective case report. RESULTS: We describe a 43-year-old otherwise asymptomatic woman with a known exposure to tuberculosis who had unilateral optic disc edema and a partial macular star (neuroretinitis). This was followed approximately 1 year later by the development of an exudative retinal detachment in the setting of bilateral multifocal choroiditis. Laboratory testing revealed a marked positive cutaneous reaction to purified protein derivative (PPD). Treatment with antituberculosis medicine alone resulted in prompt resolution of the choroidal infiltrates and complete flattening of the exudative detachment. CONCLUSIONS: Tuberculosis should be considered in the differential diagnosis for patients with neuroretinitis. ( info) |
4/88. Presumed periorbital lupus vulgaris with ocular extension. OBJECTIVE: To report an unusual case of lupus vulgaris that spread to the left anterior ocular surface. DESIGN: Case report. PARTICIPANT: An 18-year-old woman presented with an 8-month history of an infiltrative skin lesion affecting the left lower eyelid and cheek area, left globe, right lacrimal sac area, together with a cystic lesion in the foot area. TESTING/INTERVENTION: The authors describe the clinical findings, radiologic study, and histopathologic study of the conjunctiva, skin, liver, and ankle lesion. The patient was treated with antituberculous medications for 3 months. MAIN OUTCOME MEASURES: Healing of the skin, conjunctival, and bone lesions. RESULTS: The lesion of the face healed, leaving scar tissue. The left eye showed symblepharon with loss of its anterior surface features. The right eye showed no symblepharon, the bones of the foot healed with no deformity, and the liver function test results normalized after 3 months of antituberculous medications. CONCLUSION: lupus vulgaris can be associated with multiple system involvement. Its clinical presentation and behavior depend on the patient's immunity and duration of the disease. early diagnosis and appropriate management may cure the disease with no life-threatening sequelae. ( info) |
| PURPOSE: To report a case of tubercular endophthalmitis simulating retinoblastoma. methods: Case report. An 8-year-old female presented with a history of complete loss of vision and a white pupillary reflex in the left eye of 3 month's duration. RESULTS: retinoblastoma could not be excluded on the basis of clinical examination and relevant investigational studies. In the left eye, a computed tomography (CT) scan demonstrated a large vitreous mass with foci of calcification. Enucleation in the left eye was performed, and histopathological examination revealed a chronic granulomatous endophthalmitis and acid-fast bacilli consistent with tubercular pathology. CONCLUSION: This case illustrates that tubercular endophthalmitis with leukocoria and a vitreous mass containing focal calcification may simulate retinoblastoma. ( info) |
6/88. Solitary nonreactive choroidal tuberculoma in a patient with acquired immune deficiency syndrome. PURPOSE: To report a case of a solitary, nonreactive choroidal tuberculoma in a patient with acquired immune deficiency syndrome (AIDS). METHOD: Case Report. RESULTS: A 26-year-old male patient with AIDS and systemic tuberculosis was found to have a solitary 1.5-disc-diameter elevated mass just superior and temporal to the optic disc. There was no associated inflammation, exudate, hemorrhage, or serous retinal detachment. fluorescein angiography showed late hyperfluorescence in a staining pattern. The mass quickly regressed with antituberculosis therapy. CONCLUSIONS: Choroidal tuberculoma can present with little associated inflammation or retinal change in a patient with AIDS. The clinical history and knowledge of opportunistic choroidal infections in patients with AIDS helps to make the diagnosis. ( info) |
7/88. A case of multiple sclerosis with granulomatous uveitis in japan--use of the antilipoarabinomannan (LAM)-B test in differential diagnosis. PURPOSE: To report a patient with multiple sclerosis and associated with granulomatous uveitis, and how anti-lipoarabinomannan (LAM)-B antibody can play a key role in differential diagnosis. methods: Case report. RESULTS: A 35-year-old Japanese woman with multiple sclerosis, diagnosed 3 years ago, presented with blurred vision in her left eye. Ophthalmological examinations revealed granulomatous iridocyclitis in her left eye and retinal periphlebitis in both eyes. The diagnosis of tuberculosis was suspected because of a positive tuberculin skin test. However, a further examination by an anti-LAM-B antibody test excluded active tuberculosis. Her clinical findings were thought most likely to be caused by multiple sclerosis and treated with corticosteroids. CONCLUSION: We should consider the possibility of multiple sclerosis as the underlying origin in patients with granulomatous uveitis. A measurement of anti-LAM-B antibody titer may be useful in the differential diagnosis of granulomatous uveitis. ( info) |
8/88. An airman with tuberculous uveitis: case study. Tuberculosis is endemic, with nearly 2 billion carriers worldwide. aviation medical examiners should be alert to both its pulmonary and extrapulmonary manifestations, especially in the international traveler. uveitis is a rare presentation of tuberculosis, but that diagnosis must be considered in the differential, even in the absence of pulmonary disease. Promptly treated, tuberculosis should not interfere with the resumption of a career in aviation, and does not generally require special follow up. ( info) |
9/88. Primary conjunctival tuberculoma: a case report. Conjunctival tuberculoma is very rare in modern medicine. We report a case of a 34-year-old Thai female patient presenting with multiple peculiar conjunctival nodules. Two small nodules were excised and submitted for histopathological study, which showed discrete granulomatous inflammation with caseating necrosis. The acid-fast bacilli's staining for tuberculous bacteria was positive. There was no other organ involvement of active tuberculosis. The patient was then treated with systemic anti-tuberculous regimen for 6 months. The remaining lesions disappeared within the first few months of treatment. Conjunctival tuberculoma should always be considered in cases of conjunctival nodules. ( info) |
10/88. Ocular manifestations of tuberculosis. OBJECTIVE: To present the clinical and histopathologic findings in five cases of tuberculosis (TB) with various ocular manifestations. DESIGN: Observational case series. methods: Retrospective review of clinical findings, course, and treatment of five patients. Diagnostic techniques, including biomicroscopic, histopathologic, and molecular biologic test results, are presented. MAIN OUTCOME MEASURES: visual acuity, slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography results. RESULTS: The ocular manifestations of TB in our patients included panophthalmitis, endophthalmitis, posterior uveitis with choroidal tubercles, keratitis, and a lid mass. mycobacterium tuberculosis was identified in four cases in ocular specimens using acid-fast bacilli microscopy and in three cases by culture. Rapid diagnosis using polymerase chain reaction was obtained in one case. Extraocular foci of TB were identified in three cases with an intraocular infection at presentation. No patients had the human immunodeficiency virus (hiv) and none were immunocompromised. Two eyes could not be saved using antituberculous treatment because of delayed diagnosis and treatment. CONCLUSIONS: In this age of the hiv pandemic, TB is becoming more common. Because it is curable, heightened awareness and better understanding of the disease's ocular manifestations should be of concern to all ophthalmologists. ( info) |