| PURPOSE: To highlight the importance of nested polymerase chain reaction (PCR) in the detection of mycobacterium tuberculosis in a case of subconjunctival tuberculosis. methods: We report a case of a 60-year-old man with subconjunctival nodule in the right eye for duration of 6 weeks. biopsy of the nodule showed a granuloma with extensive caseation necrosis. Ziehl Neelsen staining for acid-fast bacilli (AFB) was negative. However, because of a strong suspicion of Mycobacterium infection, PCR for M. tuberculosis genome was done, using the nested PCR technique. RESULTS: polymerase chain reaction for M. tuberculosis showed amplification of mycobacterium tuberculosis genome with the nested PCR technique. CONCLUSION: Our case indicates that PCR can be a valuable tool in the diagnosis of conjunctival tuberculosis from paraffin sections. ( info) |
12/88. Ocular scrofuloderma with unilateral proptosis. Proptosis due to an extraconal orbital abscess of tubercular origin with lacrimal gland involvement, representing ocular scrofuloderma, is a rare entity. This association has not been reported earlier in the literature. We describe a 7-year-old boy who presented with nodulo-ulcerative lesions of tubercular etiology with discharging sinuses on right side of the face and a similar lesion on the right lower eyelid along with proptosis of 4 months duration. Computerized tomography (CT) scan of the head confirmed the extraconal, intraorbital, hyperdense, homogeneously enhancing mass separated from the lateral rectus muscle and further revealed involvement of lacrimal gland along with erosion of the temporal bone. The patient showed marked improvement of his dermatological and ophthalmological lesions with anti-tubercular treatment. Subsequent ultrasound examinations of the orbit revealed regression in the size of the abscess from 10.7 mm to 5.0 mm and then complete disappearance of the abscess obviating surgical intervention. ( info) |
13/88. Tuberculous choroidal granulomas in a patient with systemic lupus erythematosus. A case report. AIM: We report a case of tuberculous choroidal granulomas in a patient with systemic lupus erythematosis (SLE) who developed miliary tuberculosis (TB) and bilateral granulomas while on immunosuppressive medication. methods: The case notes of this patient were reviewed. RESULTS: The patient was first seen for base-line ophthalmic screening before anti-tuberculous medication was started. The patient was subsequently followed up at 2 weeks, 4 weeks and 2 months with fundal examination and photography. One choroidal granuloma was found in the right eye while another peripheral lesion involved the left eye. Both resolved in response to anti-tuberculous medication over a 2-month period with resultant chorioretinal atrophy and scarring. CONCLUSION: This case demonstrates the need to screen immuno-suppressed SLE patients who have miliary TB for possible eye involvement. ( info) |
| BACKGROUND: To report an unusual case of multifocal choroidopathy with uveitis and cytomegalovirus (CMV) retinitis in a patient with acquired immunodeficiency syndrome (AIDS) after initially presenting with pulmonary tuberculosis (mycobacterium kansasii). CASE: Slit-lamp biomicroscopy and indirect ophthalmoscopic examination were done. Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. Computer tomography scan, magnetic resonance imaging and biopsy of the brain were also carried out. OBSERVATIONS: Multiple yellowish-white, round, slightly elevated subretinal pigment epithelium lesions were noted in areas devoid of the atrophic retina of previous CMV infection. Anterior uveitis and vitritis were also noted. Vitreous, retina, and brain biopsy did not offer any clue for diagnosis. The visual acuity improved later, along with recovered immunity under the anti-tuberculosis medications and the cocktail therapy for AIDS. CONCLUSIONS: Combined CMV retinitis and atypical tuberculosis chorioretinitis, although rare, can develop in the patients with AIDS. Systemic dissemination of atypical tuberculosis infection should be responsible for the choroidopathy in this patient. ( info) |
15/88. Orbital tuberculosis with abscess. The authors present a case of progressive unilateral proptosis caused by tuberculous osteoperiostitis of the orbital walls and sphenoid bone with extraconal orbital and extradural intracranial cold abscess formation. The patient responded well to surgical evacuation and antituberculous medical therapy. ( info) |
16/88. Tuberculous dacryoadenitis: a rare manifestation of tuberculosis. A 41-year-old Somalian female inhabitant of The netherlands presented with malaise and cervical lymph node swelling. Enlarged mediastinal, hilar and abdominal lymph nodes were found on CT scan. Subsequently the left lacrimal gland became swollen, accompanied by periostitis of the lateral orbit margin. mycobacterium tuberculosis was cultured from lymph node tissue and the diagnosis of tuberculous dacryoadenitis with periostitis was made on CT images and histology. All lesions responded well to tuberculostatic treatment. Although tuberculous dacryoadenitis is a very rare manifestation of tuberculosis, it is still important to recognise this presentation, especially since the incidence of tuberculosis continues to increase in Western countries. ( info) |
17/88. Tuberculous granuloma managed by full thickness eye wall resection. PURPOSE: To report the use of eye wall resection in the management of tuberculous granuloma. DESIGN: Interventional case report. methods: In a 26-year-old man with biopsy-proven tuberculous granuloma of the left eye, total eye wall resection and donor scleral grafting was performed for management of tuberculous granuloma involving the sclera, part of the cornea, the iris, the chamber angle, and the ciliary body. Adjuvant therapy included oral antitubercular medication. RESULTS: The treatment of the infection was successful. The scleral graft healed well, and the crystalline lens was preserved. CONCLUSIONS: Total eye wall resection, a technique described in the management of uveal tumors, can be adopted to manage selected cases of tuberculous granuloma of the eye. ( info) |
| BACKGROUND: We report the rare case of a chorioretinitis occurring after intravesical BCG instillation to cure in situ carcinoma. history AND SIGNS: A 57-year-old man was treated for bladder carcinoma with BCG instillations. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. Bilateral chorioretinitis was discovered three months after initiation of intravesical BCG therapy. THERAPY AND OUTCOME: No progression of ocular lesions could be seen after a 6 months therapy with rifampicin, isoniazide and ethambutol. CONCLUSIONS: BCG chorioretinitis is a rare complication that can be seen after intravesical BCG therapy. BCG is a live attenuated strain of mycobacterium bovis. Two mechanisms can be proposed as the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection. ( info) |
19/88. subretinal fluid analysis in the diagnosis of choroidal tuberculosis. BACKGROUND: diagnosis of intraocular tuberculosis is often difficult. A choroidal granulomalike lesion suspected to be the result of tuberculosis could be of other inflammatory, infective, or neoplastic causes. We report two cases in which a choroidal granuloma with exudative retinal detachment was diagnosed as tuberculosis by the detection of acid-fast bacilli in subretinal fluid. methods: Interventional case series. RESULTS: Two female patients had choroidal granulomas with surrounding exudative retinal detachment. Detailed laboratory investigations were unhelpful in diagnosis, and the patients' conditions worsened with systemic steroid therapy. subretinal fluid was tapped and revealed acid-fast bacilli and grew mycobacterium tuberculosis on culture. CONCLUSION: subretinal fluid analysis can help in the detection of tuberculous granuloma and facilitate successful management. ( info) |
20/88. Ocular tuberculosis masquerading as ocular tumors. Tuberculosis has re-emerged as a serious public health problem in recent years. The ocular manifestations of tuberculosis are uncommon and diverse. Occasionally, patients initially present with ocular symptoms that simulate intraocular malignancy or other inflammatory conditions. We present five patients with ocular tuberculosis who were referred with the suspicion of ocular malignancy. Four of the five patients had recently emigrated to the united states. The presenting features of these patients were panophthalmitis (one patient), endophthalmitis leading to scleral perforation (one patient), active choroidal granuloma associated with uveitis (two patients), and amelanotic choroidal lesion without inflammatory signs (one patient). Of these five cases, two had a known history of systemic tuberculosis, while the ocular findings in the other three cases were the presenting manifestation of systemic tuberculosis. Multi-drug antituberculous regimen were employed in all cases for a mean of 9 months (median 6 months, range 6-12 months). Three patients responded well to therapy with salvage of the globe and the two remaining patients underwent primary enucleation for blind painful eye or perforated eye. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as an intraocular or epibulbar tumor. A high degree of clinical suspicion is important, especially in immigrants from developing countries. ( info) |