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Ocular manifestations of tuberculosis are nonspecific and polymorphic as they can affect all the tunics of the eye and cause severe visual loss in the absence of early and appropriate treatment. We here report 2 cases of pseudotumoral ocular tuberculosis with favorable outcome under antibacillary treatment; the first patient recently had had spontaneous burst of the eyeball with exit of a burgeoning fleshy and suppurative mass measuring 10cm/6cm, the second patient had granuloma of the ciliary body mimicking melanoma; then we here discuss the clinical and therapeutic particularities of this disease. [ABSTRACT FROM AUTHOR]

Résumé Le diagnostic de tuberculose oculaire demeure difficile malgré l’avènement, depuis plus de 10 ans, de no veaux tests immunologiques. Dans les pays à faible endémie pour la tuberculose, la mise en évidence intraoculaire de Mycobacterium tuberculosis (MT) est exceptionnelle et le diagnostic de tuberculose oculaire est principalement présomptif. Cette mise au point a pour but : de souligner les principales formes cliniques évocatrices de tuberculose intraoculaire, et les dernières classifications proposées pour poser le diagnostic de tuberculose oculaire ; de clarifier la contribution et la pertinence des tests immunologiques, type IGRA (interferon-gamma release assay), dans la prise en charge diagnostique de la tuberculose intraoculaire ainsi que leur place parmi les autres outils diagnostiques disponibles, à savoir ; clinique, immunologique (intradermoréaction à la tuberculine), bactériologique, histologique (prélèvement(s) intra/extra oculaire), et radiologique ; de comparer les stratégies diagnostiques réalisées en pays de forte ou de faible endémie pour la tuberculose ; et de rappeler les principes de la prise en charge thérapeutique des atteintes inflammatoires intraoculaires d’origine tuberculeuse. Il ressort de cette mise au point, qu’il existe de réelles différences concernant les outils diagnostiques, selon que le patient vit en zone de faible ou de forte endémie vis-à-vis de la tuberculose, avec une contribution diagnostique des radiographies thoraciques, de l’IDR et des IGRA, qui diffère significativement. Ces différences incitent à une approche diagnostique différente selon les caractéristiques de la prévalence et de la maladie où séjourne le patient. Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients. [ABSTRACT FROM AUTHOR]

Ocular manifestations of tuberculosis are non-specific and polymorphic as they can affect all the tunics of the eye and cause severe visual loss in the absence of early and appropriate treatment. We here report 2 casesof pseudotumoral ocular tuberculosis with favorable outcome under antibacillary treatment; the first patient recently had had spontaneous burst of the eyeball with exit of a burgeoning fleshy and suppurative mass measuring 10cm/6cm, the second patient had granuloma of the ciliary body mimicking melanoma; then we here discuss the clinical and therapeutic particularities of this disease., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts., (Copyright: Incaf Elboukhani et al.)

Despite extensive investigations, including the use of Interferon-gamma release assays (IGRA), the diagnosis of intraocular tuberculosis (TB) remains challenging. Ocular evidence of Mycobacterium tuberculosis in low endemic countries for TB is extremely rare, leading mostly to a TB-related ocular inflammation presumptive diagnosis. This present work aims: to highlights the main clinical patterns suggestive of ocular TB; and the latest recommended guidelines for diagnosing ocular TB to clarify interferon-gamma release assay (IGRA) contribution and accuracy to the management of intraocular TB and its diagnosis, in addition to other available diagnostic tools, such as tuberculin skin test, bacteriologic and histologic analysis from intra/extra ocular sample and radiographic investigations; to define the accuracy of these diagnostic tools according to the endemic TB prevalence; and finally to identify therapeutic strategies adapted to the main clinical presentations of ocular TB. Our review of the literature shows that management of suspected ocular TB differs significantly based on whether patients are from high or low TB prevalence countries since accuracy of chest X-ray, tuberculin skin test and IGRA is significantly different. Taking into account these discrepancies, distinct guidelines should be determined for managing patients with suspected ocular TB, taking into consideration home prevalence of TB-patients., (Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)