Multidrug-resistant tubercular posterior scleritis

Author: Irene Garcia del Moral (Spain)

Co-authors: NURIA Garcia Gallardo, Juan Francisco Martinez Jerez

Purpose

To present a case of infectious posterior scleritis in a patient with multidrug-resistant tuberculous disease and review of literature.

Setting/Venue

Ophthalmology Department University Hospital San Agustín, Linares-Jaén (Spain).

Methods

Retrospective observational case report and review of tubercular scleritis.

Results

A 49-year-old male who had complained about ocular surface symptoms for four months and was treated on several occasions for this condition presented at the Emergency Unit of our department with severe retro-ocular pain with vomiting, narrow angle and superior redness in his left eye. Intraocular pressure was normal. Nd:YAG laser iridotomy was performed and started with systemic and topic steroid therapy. Fundus examination showed a superior exudative retinal detachment, optic disc swelling and superior choroidal efussion. Workup for systemic disease displayed positive serum interferon gamma release assays (IGRA) and the patient initiated anti-tubercular treatment (ATT). After two months of ATT and steroid treatment visual acuity and exudative retinal detachment improved considerably. Five months after ATT onset the patient began complaining again of ocular surface symptoms and new IGRA testing was positive, therefore he began multidrug-resistant tubercular treatment.

Conlusions

Tubercular scleritis is a rare condition but should always be kept in mind since it is essential to rule out infection before starting immunosuppressive treatment. It may result from direct infection or an immune-mediated mycobacterial antigen-mediated inflammation. There is a wide range of ocular manifestations in tubercular disease.

Financial Disclosure

No financial disclosure to declare.