Unilateral choroidal tuberculoma as an initial manifestation of presumed ocular tuberculosis: a case report / Tuberculoma coroidal unilateral como manifestação inicial de tuberculose ocular presumida: relato de caso

ABSTRACT Choroidal tuberculomas are present in patients with ocular tuberculosis. They usually occur in a patient with previous history of tuberculosis, and are rarely the initial presentation, with no prior systemic manifestations. We present a patient with unilateral choroidal tuberculoma as the initial presentation of presumed ocular tuberculosis, which enabled earlier initiation of treatment.

RESUMO Os tuberculomas de coroide apresentam-se em pacientes com tuberculose ocular. Geralmente, ocorrem em indivíduos com história prévia de tuberculose e raramente têm apresentação inicial sem manifestações sistêmicas anteriores. Relatamos o caso de um paciente com tuberculoma de coroide unilateral com apresentação inicial de tuberculose ocular presumida, permitindo o início mais precoce do tratamento.

Metástasis coroidea como manifestación inicial de adenocarcinoma de pulmón en paciente joven: informe de caso / Choroidal metastasis as an initial manifestation of lung adenocarcinoma in a young patient: case report

Introducción: se presenta el caso de un paciente de 36 años, a quien se le realizó el diagnostico de tuberculoma coroideo, otorgando tratamiento sin mejoría de los síntomas. Posteriormente fallece dilucidándose el diagnóstico de adenocarcinoma de pulmón con metástasis a coroides. Objetivo: informar el diagnóstico de metástasis coroidea como manifestación inicial, de adenocarcinoma de pulmón, en un paciente joven. Diseño de estudio: reporte de caso. Resumen del caso: masculino de 36 años de edad, antecedente de tuberculosis en la infancia, tabaquismo positivo no significativo. Presenta baja visual de ojo derecho, siendo diagnosticado con tuberculoma coroideo, asociado a sudoración nocturna, lumbalgia, tos y QuantiFERON-TB positivo. Se inicia tratamiento antituberculosis. Posterior, presenta deterioro respiratorio y neurológico requiriendo intubación orotraqueal, ulteriormente fallece. La autopsia elucida el diagnóstico de adenocarcinoma de pulmón con metástasis a coroides, hígado y riñón. Conclusión: las metástasis coroideas conllevan un mal pronóstico visual y sistémico, se requiere un alto índice de sospecha en pacientes menores de 50 años sin factores de riesgo. Se convierten en un reto diagnóstico, sobre todo en países donde predominan las enfermedades infecciosas. El papel del oftalmólogo es realizar el diagnóstico oportuno y correcto, evitando así retrasar el tratamiento.

Background: the case of a 36 year-old patient is presented, who was diagnosed with choroidal tuberculoma, giving treatment without improvement. Then, the diagnosis of pulmonary adenocarcinoma and choroidal metastases was elucidated. Objective: to report the diagnosis of metastasis as the initial manifestation of lung adenocarcinoma in a young patient. Study design: case report. Case summary: male, 36 years old, history of tuberculosis in childhood, positive smoking, but not significant. He presented visual loss of the right eye, being diagnosed with a choroidal tuberculoma, associated with night sweats, cough and positive QuantiFERON-TB test, treatment for tuberculosis was initiated. Later he had respiratory and neurological deterioration requiring orotracheal intubation, but unfortunately he died. Autopsy reveals lung adenocarcinoma with choroidal, liver and kidney metastases. Conclusion: choroidal metastases lead to poor visual and systemic prognosis, a high suspicion is required in patients under 50 years of age without risk factors. They become a diagnostic challenge, especially in countries where infectious diseases are predominat. The ophthalmologist's role is to make the diagnosis timely and correctly, thus avoiding delaying treatment.

Aspectos clínicos e tratamento de pacientes com tuberculose ocular presumida em centro de referência de São Paulo, Brasil. Estudo retrospectivo / Clinical description and treatment of patients with presumed ocular tuberculosis in São Paulo, Brazil. Retrospective study

Resumo Objetivo: Descrever aspectos clínicos e esquema terapêutico dos pacientes com tuberculose ocular presumida tratados em um centro de referência em tuberculose de São Paulo. Métodos: Estudo retrospectivo descritivo. O teste exato de Fisher foi realizado quando apropriado. Resultados: A queixa mais comum foi baixa acuidade visual (83,1%), seguida por dor ocular generalizada (25,3%) e visão turva (22,8%). A uveíte posterior foi a apresentação mais comum (35,7%). O tratamento consistiu no esquema atualmente recomendado de rifampicina, isoniazida, pirazinamida e etambutol (RHZE). A prednisona oral foi incluída no tratamento de 37 pacientes, para tratamento da inflamação aguda, embora não tenha diminuído a prevalência de complicações crônicas, em comparação com a recuperação completa (p = 0,1). O diagnóstico precoce (<70 dias) foi associado a maiores taxas de recuperação total (p = 0,005). Não houve significância estatística quando se comparou a terapia de 6 a 9 meses (p = 0,7). Conclusão: A uveíte tuberculosa pode ser tratada por uma terapia com duração de seis meses. Um breve curso de esteroides melhora os sintomas agudos, embora não reduza as complicações a longo prazo.

Abstract Purpose: To analyze and describe the therapy used in presumed ocular tuberculosis in a referral center in São Paulo, Brazil. Methods: Retrospective, descriptive study. Fisher's exact test was performed when appropriate. Results: The most common complaint was low visual acuity (83.1%), followed by generalized ocular pain (25.3%) and blurred vision (22.8%). Posterior uveitis was the most common presentation (35.7%). Treatment consisted of the currently recommended association of rifampin, isoniazid, pyrazinamide, ethambutol (RHZE) regimen. Oral prednisone was included in the treatment of 37 patients for acute inflammation, although it did not significantly decrease the prevalence of chronic complications compared to full recovery (p = 0,1). Early diagnosis (< 70 days) was associated with higher rates of full recovery (p = 0.005). No statistical significance was observed when comparing 6 to 9-month therapy (p = 0.7). Conclusion: Tuberculous uveitis can be treated with a 6-month duration RHZE therapy. A brief course of steroids may improve acute symptoms, although it did not reduce long-term disabilities.

Unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strongly positive purified protein derivative test / Epiteliopatia pigmentar placóide multifocal posterior aguda unilateral na presença de reação forte positiva para o teste tuberculínico

ABSTRACT A 27-year-old man presented with a complaint of decreased visual acuity in the right eye. Best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Right eye fundoscopy revealed mild vitritis, multifocal yellowish lesions, and macular serous retinal detachment. Left eye evaluation was normal. Acute posterior multifocal placoid pigment epitheliopathy was diagnosed in the right eye. Complementary exams revealed a strong reaction to the Mycobacterium tuberculosis purified protein derivative test, thus treatment for tuberculosis was initiated. Baseline fluorescein angiography of the right eye revealed early hypofluorescence and late staining of the lesions. Optical coherence tomography of the right eye demonstrated the accumulation of subretinal and intraretinal fluid associated with cystoid macular edema. During follow-up, the retinal fluid and cysts disappeared, which was followed by disorganization of foveal interdigitation and ellipsoid zones. This is the second described case of unilateral acute posterior multifocal placoid pigment epitheliopathy in a patient with a strong positive result to the M. tuberculosis purified protein derivative test.

RESUMO Um homem de 27 anos apresentou uma queixa de diminuição da acuidade visual no olho direito. A acuidade visual melhor corrigida foi 20/60 no olho direito e 20/20 no olho esquerdo. A fundoscopia do olho direito revelou vitreíte leve, lesões amareladas multifocais e descolamento seroso da retina em região macular. A avaliação do olho esquerdo foi normal. Epiteliopatia pigmentar placóide multifocal posterior aguda foi diagnosticada no olho direito. Os exames complementares revelaram forte reação ao teste do derivado proteico purificado Mycobacterium tuberculosis, iniciando terapia antibiótica contra tuberculose. A angiografia fluoresceínica basal do olho direito revelou hipofluorescência precoce e tardia das lesões. A tomografia de coerência óptica do olho direito demonstrou fluído sub- e intrarretiniano associado a edema macular cistóide. Durante o seguimento, os fluídos e cistos retinianos desapareceram, seguido da desorganização das zonas de interdigitação e elipsóide em região foveal. Este é o segundo caso descrito de epiteliopatia pigmentar placóide multifocal posterior aguda unilateral em um paciente com um forte resultado positivo para o teste tuberculínico.

Potencial do teste IGRA (Interferon Gama Release Assay) para o diagnóstico de tuberculose ocular. Revisão e análise comparativa com o teste tuberculínico cutâneo (PPD) / The potential of the IGRA (Interferon Gamma Release Assay) test for the diagnosis of ocular tuberculosis. Review and comparative analysis with the tuberculosis skin test

Resumo A detecção precisa da infecção latente por tuberculose está se tornando cada vez mais importante devido ao aumento do uso de medicamentos imunossupressores e da epidemia do vírus da imunodeficiência humana, o que aumentou o risco de reativação à tuberculose ativa (TB). O Teste IGRA QuantiFERON® TB Gold apresenta vantagens frente ao teste de PPD como por exemplo, requer somente uma coleta de amostra sanguínea ; não há necessidade que o paciente retorne ao laboratório para leitura e interpretação dos resultados; Os resultados são objetivos, não requerem interpretação do leitor ou interferência de critérios subjetivos; trata-se de um teste in vitro, portanto não há "efeito booster" (potenciação da reação tuberculínica); o teste não é afetado por vacinação prévia por BCG ou infecção por outras espécies de micobactérias. Limitações são descritas, apesar de raras, como reações cruzadas deste método com infecções por algumas espécies de micobactérias não-tuberculosis (incluindo Mycobacterium kansasii, Mycobacterium szulgai e Mycobacterium marinum). Ainda há poucos dados sobre o teste IGRA em certas populações, como por exemplo, em crianças, pacientes imunocomprometidos e mulheres grávidas. Nestes grupos, a interpretação do teste pode ser difícil e mais estudos se fazem necessários.

Abstract Precise detection of latent tuberculosis infection is becoming increasingly important due to increased use of immunosuppressive drugs and the human immunodeficiency virus epidemic , which increased the risk of reactivation to active tuberculosis (TB).The QuantiFERON® TB Gold IGRA Test has advantages over the skin test for TB, otherwise known as a Mantoux tuberculin test, for example, requires only a blood sample collection; there is no need for the patient to return to the laboratory for reading and interpretation of the results; The results are objective, do not require interpretation of the reader or interference of subjective criteria; it is an in vitro test, so there is no "booster effect" (potentiation of the tuberculin reaction); the test is not affected by prior BCG vaccination or infection with other species of mycobacteria. Limitations are described, although rare, as cross-reactions of this method with infections by some species of non-tuberculosis mycobacteria (including Mycobacterium kansasii, Mycobacterium szulgai and Mycobacterium marinum). There is still little data on the IGRA test in certain populations, such as in children, immunocompromised patients and pregnant women. In these groups, the interpretation of the test can be difficult and more studies are needed.

Anterior uveitis as a manifestation of ocular tuberculosis / Uveíte anterior como manifestação de tuberculose ocular

ABSTRACT Tuberculosis (TB) is an infectious disease of great magnitude in the world. Of patients with extrapulmonary disease, ocular manifestations are rare but among reported cases the most common ocular manifestation is uveitis. The diagnosis of ocular TB should be made as early as possible so that treatment is initiated and the risks of ocular complications are minimized. The objective of this study is to report an ocular TB case that presented as anterior uveitis. A 52-year-old female patient, a nursing technician at a large hospital, presented a history of low visual acuity associated with myiodesopsia for 4 days. Her ophthalmologic history included an iridotomy due to narrow angle in both eyes. On examination, the best corrected visual acuity was 20/100, right eye, and 20/80, left eye. Among the most significant ocular alterations were granulomatous keratic precipitates, anterior chamber reaction, flare and light vitreitis, corresponding to anterior uveitis. Based on clinical history and ophthalmologic examination, tests were ordered that corroborated the diagnosis of ocular TB. Thereafter, antituberculous therapy was instituted with a good response in 15 days, including improvement in visual acuity. The patient was followed-up by ophthalmology and infectology. Intraocular TB should be considered in the differential diagnosis of any type of intraocular inflammation. The diagnosis of presumed ocular TB is a clinical challenge with the diagnosis modalities currently available. The faster the onset of treatment, the better the visual prognosis of the affected patient.

RESUMO A tuberculose (TB) é uma doença infecciosa de grande magnitude no mundo. Dos pacientes com doença extrapulmonar, as manifestações oculares são raras, mas entre os casos relatados, a manifestação ocular mais comum é a uveíte. O diagnóstico de TB ocular deve ser feito o mais precoce possível para que o tratamento seja iniciado e os riscos de complicações oculares sejam minimizados. O objetivo deste estudo é relatar um caso de TB ocular que se apresentou como uveíte anterior. Uma paciente do sexo feminino, 52 anos, técnica de enfermagem de um hospital de grande porte, apresentou história de baixa acuidade visual associada à miodesopsia por 4 dias. Sua história oftalmológica incluía uma iridotomia devido ao ângulo estreito em ambos os olhos. No exame, a melhor acuidade visual corrigida foi 20/100, olho direito, e 20/80, olho esquerdo. Dentre as alterações oculares mais significativas, destacam-se precipitados ceráticos granulomatosos, reação de câmara anterior, flare e vitreíte leve, correspondendo à uveíte anterior. Com base na história clínica e no exame oftalmológico, foram solicitados exames que corroboram o diagnóstico de TB ocular. Posteriormente, a terapia antituberculosa foi instituída com uma boa resposta em 15 dias, incluindo melhora na acuidade visual. A paciente foi acompanhada pelas especialidades: oftalmologia e infectologia. A TB intraocular deve ser considerada no diagnóstico diferencial de qualquer tipo de inflamação intraocular. O diagnóstico presumível de tuberculose ocular é um desafio clínico com as modalidades de diagnóstico atualmente disponíveis. Quanto mais rápido o início do tratamento, melhor o prognóstico visual do paciente afetado.

The impact of ocular tuberculosis on vision after two months of intensive therapy

ABSTRACT Tuberculosis is an infectious disease of global importance with major economic and social burden accounting for 25% of all avoidable deaths in developing countries. Extrapulmonary involvement may occur either in association with clinically apparent pulmonary tuberculosis or in isolation. This cross-sectional descriptive study aimed to evaluate the impact of ocular tuberculosis in visual acuity at baseline and after two months of intensive anti-tuberculous therapy. A sample of 133 pulmonary tuberculosis patients, seven disseminated tuberculosis, and three pleural tuberculosis patients was evaluated. All patients underwent routine ophthalmic evaluation, including assessment of visual acuity, biomicroscopy, applanation tonometry, indirect ophthalmoscopy, and fluorescent angiography as appropriate. None of the patients had impaired visual acuity due to tuberculosis. A rate of 4.2% (6/143) of ocular involvement was found. None of the patients with ocular involvement were HIV-infected. Of the six patients with ocular involvement, five met the diagnostic criteria for probable and one for possible ocular lesions. As for the type of ocular lesions, two patients had bilateral findings: one had sclerouveitis and the second had choroidal nodules. The other four patients presented with unilateral lesions: peripheral retinal artery occlusion in the right eye (one case), choroidal nodules in the left eye (one case), and choroidal nodules in the right eye (two cases). Patients progressed favorably after two month of intensive therapy, with no significant reduction in vision.

Optical Coherence Tomography Features of Tuberculous Serpiginous-like Choroiditis and Serpiginous Choroiditis / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate optical coherence tomography (OCT) characteristics of tuberculous serpiginous-like choroiditis (Tb-SLC) and serpiginous choroiditis (SC) and to perform OCT to differentiate between these conditions.</p><p><b>METHODS</b>This retrospective, case-control study examined consecutively enrolled patients with active Tb-SLC or SC. Patients underwent comprehensive ocular examinations and imaging (OCT, color fundus photography, autofluorescence imaging, fluorescein angiography, and indocyanine green angiography). Findings were examined and compared between eyes with SC and Tb-SLC.</p><p><b>RESULTS</b>Nine patients with active Tb-SLC (14 eyes) and 8 with active SC (12 eyes) were included. The following OCT findings were observed significantly more often in the Tb-SLC group than in the SC group: vitreal hyper-reflective spots [5 Tb-SLC eyes (36%), no SC eyes; P = 0.02], intraretinal edema [11 Tb-SLC eyes (79%), 3 SC eyes (25%); P = 0.01], sub-retinal pigment epithelium (RPE) drusenoid deposits [11 Tb-SLC eyes (79%), 2 SC eyes (17%); P < 0.01], and choroidal granulomas [8 Tb-SLC eyes (57%), 2 SC eyes (17%); P = 0.03]. A hyporeflective, wedge-shaped band was observed more often in the SC group [5 Tb-SLC eyes (36%), 9 SC eyes (75%); P = 0.045] than in the Tb-SLC group. The incidence of other OCT signs did not differ between the groups and included outer nuclear layer hyper-reflection, outer retinal tabulation, and choriocapillaris point-like hyper-reflection.</p><p><b>CONCLUSION</b>Vitreal hyper-reflective spots, intraretinal fluid, sub-RPE drusenoid deposits, and choroidal granulomas on OCT images may indicate Tb-SLC. Additionally, a hyporeflective, wedge-shaped band may indicate SC. Therefore, OCT is likely helpful in differentiating between Tb-SLC and SC.</p>

Isolated posterior scleritis associated with tuberculosis / Esclerite posterior isolada associada à tuberculose

ABSTRACT Ocular tuberculosis (TB) is considered to be rare, although its incidence has varied widely over time and in different populations. Latent TB is diagnosed when a person is infected with Mycobacterium tuberculosis but does not have active TB. During the last decade, interferon-gamma release assay tests have been developed that allow identification of patients with latent TB infection with better specificity than the tuberculin skin test and can differentiate between infection and prior vaccination. Although rare, tuberculous scleritis should be considered in the differential diagnosis of posterior scleritis. Here we describe a patient with posterior scleritis and severe visual loss associated with latent TB without uveitis, anterior scleritis, keratitis, or any other previous ocular disease history. The patient responded well to a combined treatment of antitubercular therapy and oral corticosteroids.

RESUMO A tuberculose (TB) ocular foi considerada rara, embora a sua incidência tenha variado significativamente ao longo do tempo e nas diferentes populações. A TB latente é diagnosticada quando alguém é infetado com Mycobacterium tuberculosis sem possuir doença ativa. Durante a última década, testes tendo por base interferon gamma release assay foram desenvolvidos, permitindo a identificação de pacientes com infeção por tuberculose latente com maior especificidade que o teste tuberculínico e diferenciar infeção e vacinação prévia. Embora rara, a esclerite tuberculosa deve ser tida em consideração no diagnóstico diferencial de esclerite posterior. Reportamos um paciente com esclerite posterior e baixa grave de acuidade visual associada a TB latente, sem uveíte, esclerite anterior, ceratite ou história de doença ocular prévia. O paciente respondeu favoravelmente a um tratamento combinado de fármacos antituberculose e corticoides orais.

Granuloma macular por tuberculose sem manifestação pulmonar / Macular granuloma due to tuberculosis without pulmonary symptoms

Tuberculose é uma doença infecciosa causada pelo Mycobacterium tuberculosis, também conhecido como bacilo de Koch. O principal sítio de acometimento é o pulmonar, porém o bacilo pode disseminar-se por via linfo-hematogênica para outros órgãos, dentre eles o olho. A incidência de tuberculose ocular é de 1 a 2% dos casos extrapulmonares. Os autores apresentam um caso clínico de um paciente do sexo feminino de 28 anos que procura atendimento médico devido à redução da acuidade visual em olho esquerdo há 7 dias. Apresentava a melhor acuidade visual corrigida no olho acometido de 20/200 e no olho contralateral de 20/20. Na fundoscopia era evidenciado um granuloma em área macular do olho esquerdo, com edema e hemorragia intrarretiniana adjacente. Após investigação diagnóstica, a paciente foi tratada com esquema antibiótico para tuberculose durante 6 meses, obtendo regressão do granuloma e melhora da acuidade visual deste olho para 20/50.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis.The main site of involvement is the lung, but the bacillus may spread by hematogenous/lymph systems to other organs, including the eye.The incidence of ocular TB is 1-2% of extra-pulmonary cases. The authors present a case of a 28 years old female patient seeking medical care due to reduction of visual acuity in the left eye for 8 days. She had the best corrected visual acuity in the affected eye of 20/200, and the opposite eye was 20/20. At fundoscopy was shown a granuloma in the macular area of the left eye, with retinal edema and hemorrhage. After diagnostic investigation the patient was treated with antibiotic therapy for tuberculosis during 6 months, obtaining lesion regression and visual acuity improvement to 20/50.

Mode of presentations and management of presumed tuberculous uveitis at a referral center

The diagnosis of tuberculous uveitis is often presumptive, because of the difficulty in obtaining microbiological evidence. The diagnosis has to rely on characteristic ocular findings, and possibly a therapeutic treatment trial. To illustrate the mode of presentations and management of presumed tuberculous uveitis at a referral eye center in Iraq. This prospective case series study included patients with presumed ocular tuberculosis presented consecutively at uveitis clinic/ Ibn Al-Haetham teaching eye hospital, from January 2007-January 2013. Ocular tuberculosis was presumed when findings were consistent with possible intraocular tuberculosis, intractable to steroid therapy, and no clinical or laboratory evidence for other causes of uveitis. Strongly positive tuberculin skin test result [more than14 mm area of induration/necrosis] supported the diagnosis, but was not a prerequisite for initiating therapy. All patients were treated with anti tuberculosis therapy. Clinical findings and response on treatment were documented in a special follow up cards. 64 patients with presumed TB uveitis were included in this study. Mean age of the patients was 35.7 years with no significant sex predominance. Majority of patients were from urban places [79.7%]. Bilateral involvement was recorded in 62 patients. Vitritis was a universal finding, while multifocal choroiditis was the most common fundus lesions [104 eyes; 82.5%]. All patients responded well to anti tuberculosis therapy. Systemic corticosteroids were added after few days in 14 patients to decrease inflammatory reaction, retinal vasculitis, macular edema and macular scaring. According to this study; vitritis with multifocal choroiditis is the most common mode of presentation in patients with presumed TB uveitis. All cases responded well to anti-tuberculosis therapy, systemic corticosteroids can be added to decrease inflammatory reaction, retinal vasculitis, macular edema and macular scaring

A Case of Paradoxical Reaction after Treatment of Eyelid Tuberculosis

No abstract available.

The Usefulness of Interferon-gamma Release Assay for Diagnosis of Tuberculosis-related Uveitis in Korea

PURPOSE: To evaluate the usefulness of the interferon-gamma release assay (IGRA) for diagnosing tuberculosis (TB)-related uveitis (TRU). METHODS: Records from 181 patients with ocular signs and symptoms suggestive of TRU and intraocular inflammation of unknown etiology were reviewed. All subjects underwent clinical and laboratory testing, including IGRA, to rule out presence of underlying disease. A diagnosis of presumed TRU was made based on an internist's TB diagnosis and a patient's response to anti-TB therapy. Sensitivity, specificity, and positive predictive values of IGRA for TRU diagnosis were calculated. Clinical characteristics were compared between patients with positive and negative IGRA results. RESULTS: The sensitivity and specificity of IGRA for TRU were 100% and 72.0%, respectively. Mean age, percentage of patients with retinal vasculitis, and the anatomic type of uveitis were significantly different between patients with positive and negative IGRA results (all p < or = 0.001). Positive IGRA rates and false-positive rates were significantly different between age and anatomic type groups (both p = 0.001). The positive predictive value of the IGRA among patients with intraocular inflammation was high (70%) when all of younger age (< or =40 years), posterior uveitis, and retinal vasculitis were present. CONCLUSIONS: The IGRA is useful for diagnosing TRU in the Korean population, especially when it is used as a screening test. Clinical characteristics, including younger age (< or =40 years), posterior uveitis, and retinal vasculitis in IGRA-positive patients, increase the likelihood of the patient having TRU.

Clinical characteristic and therapy results of presumed ocular tuberculosis and their relation to HIV status.

Background: Ocular tuberculosis (TB) emerges as an important cause of intraocular inflammation, partly due to the increasing number of HIV/AIDS patients. This study attempts to identify ocular signs that are associated with ocular TB and assess the efficacy of the treatment and their relation to HIV status. Methods: Medical records of all 56 patients diagnosed with presumed ocular TB in Cipto Mangunkusumo Hospital between January 2006 and December 2011 were reviewed. Demographic and clinical characteristics and HIV status were recorded as well as efficacy of treatments given. Results: There were 39 patients included with mean age 35.38 ± 13.1 and male to female ratio was 2:1. Unilateral involvement was in 26 (66.7%) patients. From all, four (10.3%) had anterior uveitis, 14 (35.9%) posterior uveitis, 21 (53.8%) panuveitis, and none had intermediate uveitis. Most of them (32/82.1%) have concurrent other organ TB. Five out of 8 (62.5%) HIV positive patients had granulomatous inflammation and 3 (37.5%) had non-granulomatous inflammation and all eight of them had concurrent other organ TB. The other 7 known non-HIV patients, six (85.7%) have non-granulomatous inflammation. Treatment with anti-tubercular therapy (ATT), combination ATT and steroid or steroid alone increased visual acuity. However steroid alone was slightly have more frequent recurrences (1.4 ± 0.89 episodes of inflammation). Conclusion: Ocular TB in our study had variable clinical manifestations and ocular inflammation was predominantly non-granulomatous in HIV negative patients and granulomatous in HIV infected patients. All HIV positive patients the ocular TB was always accompanied by manifestations in other organs. The treatment with steroids solely resulted in improved vision but was characterized by frequent recurrences.

A Case of Ciliary Body Tuberculoma Causing Sclera Melting

PURPOSE: To report a case of ciliary body tuberculoma, which induced scleral melting. CASE SUMMARY: A 32-year-old man, who was diagnosed with miliary pulmonary tuberculosis 1 week earlier, presented with a conjunctival injection and mass on his right eye 3 months in duration. On excisional biopsy, melted sclera and exposed uveal tissue were found; acid-fast stain was positive. Two months after anti-tuberculosis treatment, anterior granulomatous uveitis and granuloma formation on the anterior chamber angle developed. A low-dose systemic steroid therapy was added. Six weeks after systemic steroid therapy, anterior uveitis and granuloma on anterior chamber angle disappeared. CONCLUSIONS: We experienced a case of ocular tuberculosis on the ciliary body. A low-dose systemic steroid along with multi-drug anti-tubercular therapy may be an effective treatment of ciliary body tuberculoma.

Tuberculose intraocular / Intraocular tuberculosis

A Tuberculose (TB) é uma doença infecciosa causada pelo Mycobacterium tuberculosis (Mtb), que acomete principalmente os pulmões. Ela pode acometer qualquer parte do olho, porém o local mais acometido é a úvea. A incidência de envolvimento de TB ocular e em outros sítios é de 1 por cento a 2 por cento. Alguns autores descrevem várias alterações intraoculares, tendo apresentações clínicas das mais variadas, uveíte anterior, posterior, intermediária e panuveíte. Nesta revisão iremos tratar especificamente de TB intraocular, discutindo sobre as diversas manifestações, diagnóstico e tratamento.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb), which attacks mainly the lungs. This disease can also attack any part of the eye; however, the more attacked ocular site is the uvea. The incidence of involvement of ocular and other sites TB is of 1 percent to 2 percent. Some authors describe several intraocular alterations, presenting the most varied clinical presentations, such as anterior, posterior, and intermediate uveitis, as well as panuveitis. In this revision, we will approach specifically the intraocular TB, discussing about its different manifestations, diagnosis, and treatment.

Posterior scleral tuberculoma: case report / Tuberculoma escleral posterior: relato de caso

Posterior scleral tuberculoma formation is an extremely rare condition. The few reports on scleral involvement in tuberculosis refer to cases of anterior scleritis. In the present manuscript we describe a patient who had rheumatoid arthritis and developed a large posterior scleral tuberculoma. The lesion provoked retinal detachment and visual loss and was diagnosed only after enucleation due to a misdiagnosis of choroidal melanoma.

A formação de granuloma tuberculoso na esclera posterior é um evento extremamente raro. Os poucos relatos de acometimento escleral na tuberculose referem-se a casos de esclerite anterior. No presente trabalho é descrito um caso de granuloma escleral posterior em um paciente portador de artrite reumatóide. A lesão provocou descolamento da retina e perda visual e só foi diagnosticada após enucleação por suspeita de melanoma de coróide.

Perfil epidemiológico dos pacientes portadores de tuberculose extrapulmonar atendidos em hospital da rede pública no estado do Maranhão / Epidemiological profile of patients with extrapulmonary tuberculosis in a public hospital in state of Maranhão

JUSTIFICATIVA E OBJETIVOS: Embora conhecida desde a antiguidade, a tuberculose (TB) continua preocupando as autoridades sanitárias até os dias de hoje. O presente estudo teve como objetivo descrever o perfil clínico e epidemiológico dos pacientes diagnosticados com tuberculose extrapulmonar (TBEP) atendidos em hospital da rede pública de saúde no estado do Maranhão. MÉTODO: Trata-se de uma análise descritiva, com abordagem quantitativa. Foram analisados 133 prontuários de pacientes portadores de TBEP que receberam atendimento na unidade hospitalar referida no período de abril de 2007 a abril de 2009. RESULTADOS: Verificou-se predomínio do sexo masculino (61,4%), adultos jovens (51,8%) e com relação aos aspectos clínicos, apenas 14,3% dos pacientes apresentaram TBEP. A baciloscopia foi realizada em 86% dos pacientes; e destes apenas 9% apresentaram resultado positivo. A cultura foi empregada em 8,3%. Quanto à evolução 58,6% obtiveram cura, três foram a óbito (2,2%) e houve apenas três casos de abandono (2,2%) do Programa de Controle de Tuberculose (PCT) do Município. CONCLUSÃO: Este estudo possibilitou conhecer características da TBEP na população estudada, além de avaliar, indiretamente,o serviço de saúde dirigido ao controle da doença.

BACKGROUND AND OBJECTIVES: Although it is widely known since very ancient times, tuberculosis (TB) continues to preoccupy medical authorities nowadays. This study describes the clinical and epidemiological profile of extrapulmonary tuberculosis(ETB) cases assisted in a TB specialty public hospitallocated in São Luís, MA. METHOD: A descriptive analysis with a quantitative approach was made in order to support this study; 133 medical reports were analyzed and data from individual tuberculosis Investigation files and tuberculosis case registries were compiled, within the time span between April/2007 and April/2009. RESULTS: Disease occurred predominantly in males (61.4%),and in young adults (51.8%). As for the clinical presentation,only 14.3% of the total patients were diagnosed with extrapulmonary tuberculosis. Bacilloscopy was performed in 86% of these patients, within which only 9% had a positive result. Culture was performed in only 8.3% of patients. Among the patients treated by the Municipal Tuberculosis Control Program (PCT),58.6% were cured; 2.2% died and 2.2% (3 cases) abandoned treatment. CONCLUSION: This investigation permits an improved understanding of extrapulmonary tuberculosis characteristics in this particular setting and enables an indirect evaluation of the public healthcare system treatment of this disease.

Atypical Ocular and Optical Coherence Tomographic Findings With Presumed Miliary Tuberculosis

PURPOSE: To report clinical features and optical coherence tomographic findings of presumed atypical ocular tuberculosis associated with tuberculosis lymphadenitis and encephalomeningitis. CASE SUMMARY: A 28-year-old female with lymphadenitis in the axillary area presented with a fever and headache of a one week duration. CSF study and MRI findings implied tuberculosis encephalomeningitis, and presumed tuberculosis uveitis manifested with visual disturbance after five days. Ocular symptoms were aggravated and showed anterior iridocyclitis, vitritis, macular edema, and multifocal retinitis with miliary granuloma that was distinct from choroiditis or typical tuberculosis granuloma. After the patient received anti-tuberculosis medication and systemic corticosteroids, significant improvements in visual acuity, ocular findings and OCT results were observed. CONCLUSIONS: Ocular tuberculosis can present with various clinical findings, and caution should be taken so as not to misdiagnose based on these characteristics. In the present case, anti-tuberculosis medication and systemic steroids resulted in the resolution of inflammation. In such cases, monitoring the posterior pole lesion via OCT may be helpful in determining improvement.