Uncommon presentation of tuberculosis related uveitis: a case report

Author: Mohd Ihsan Jamaludin (Malaysia)

Co-authors: Ayesha Mohd Zain

Purpose

Reporting a case of impending central retinal vein occlusion (CRVO) as a rare presentation of TB-related uveitis.

Setting/Venue

Eye clinic, Universiti Kebangsaan Malaysia Medical Centre

Methods

Case report

Results

47 years old gentleman presented with first episode of left eye redness associated with photophobia and floaters. His visual acuity of the left eye was 6/18 with pinhole 6/9. Left eye revealed anterior chamber inflammation as evidenced by anterior chamber cells with fibrin and posterior synechiae. Fundus showed mild optic disc swelling, dilated and slightly tortuous vessels with multiple dot and blot retinal haemorrhages on all four quadrants. His right eye examination was normal. One week review showed reduction in the anterior chamber inflammation with topical dexamethasone prescribed. However, the retina showed worsening retinal haemorrhages. Fundus fluorescein angiography (FFA) showed evidence of CRVO with delayed venous filling, optic disc staining and small vessels leakages. Investigation showed positive TB QuantiFERON test with a normal chest x-ray. Other infectious screenings were negative. Full blood count and connective tissue disease screening tests were normal. Ultrasound carotid doppler showed absence of stenosis. The subsequent review shows self-resolution of the retinal haemorrhages and stabilization of vision at 6/9. Anti-tuberculosis and corticosteroids were not initiated and the patient was closely monitored. Repeated FFA showed resolution of vessel leakage with no evidence of retinal ischaemia.

Conlusions

'- CRVO has been reported as an ocular presentation of ocular tuberculosis. The pathogenesis can be due to vasculitis as a result of hypersensitivity reaction or direct compression from tubercle or venous blockage by the mycobacterium. - Multimodal imaging such as FFA and optical coherent tomography (OCT) are helpful in managing patients with ocular inflammatory disease.

Financial Disclosure

none