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Purpose To describe a novel clinical and imaging finding in patients with tubercular posterior uveitis. Methods A retrospective review of 3 cases presented at a tertiary referral eye centre in North India between June 2016 to March 2019 was performed. All the patients had received an initial diagnosis of non-infective etiologies (sympathetic ophthalmia, necrotizing scleritis and lymphoma). Fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), and enhanced-depth imaging optical coherence tomography (EDI-OCT) were reviewed. Results Three patients (all Asian Indian females: aged 18, 49 and 52 years) diagnosed with panuveitis were investigated for various etiologies based on the initial clinical suspicion. During the course of therapy, all the patients developed peripheral yellow sub-retinal pigment epithelim (RPE) deposits (YSRPE) which appeared hypo-autofluorescent on FAF, and initially hypofluorescent with late hyperfluorescence on FA. The patients were subjected to detailed systemic evaluation and laboratory tests. All the patients showed acid fast bacilli on invasive tissue biopsies. After initiation of anti-tubercular therapy, the lesions resolved in all eyes. Conclusions YSRPE deposits represent a novel and important diagnostic sign of tubercular posterior uveitis.

Purpose: To evaluate the clinical features and management of presumed ocular tuberculosis (OTB). Method: A prospective 3-year follow-up study of patients with ocular inflammation that performed Interferon-gamma release assay (IGRA) and tuberculin skin test (TST) was conducted in a tertiary referral center in Brazil. Patients with clinical signs highly suspect of OTB with a positive TST and/or IGRA with other causes ruled out were prescribed anti-tuberculosis therapy (ATT) during 9 months. Clinical features and treatment outcomes were recorded. Results: Seventy-two patients (mean age 48.3 ± 15.7 years) were included in the study, and most were female (65.3%, n = 47). Posterior uveitis (43.1%, n = 31) was the main clinical feature. Multifocal choroiditis (25%, n = 18) was the most common choroidal involvement. Concomitant oral prednisone (45.8%, n = 33) during ATT was associated with more recurrences ( p = 0.04). A significant difference ( p Conclusion: In our cohort some variation in demographics and ocular phenotypes of presumed OTB was observed. The high rates of cure or remission of our patients strongly support the ATT in presumed OTB. Oral corticosteroids during ATT were associated with higher recurrences rates.

Background: Polymerase chain reaction (PCR) is currently considered the method of choice for diagnosing ocular tuberculosis. However, the sensitivity and specificity of PCR using ocular samples remain uncertain. Our meta-analysis aimed to review the diagnostic accuracy of PCR testing in confirming ocular tuberculosis, with responses to antitubercular therapy (ATT) as reference indices. Methods: A systematic literature search of the PubMed, EBSCOHost, Scopus, and Google Scholar databases was performed using the standardized PRISMA guideline. Observational studies reporting both PCR MTb positivity and ATT response were included. Meta-analysis was performed to estimate the pooled positivity rate, sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios (DOR), and summary receiver operating curves (SROC). Results: The pooled positivity rate for PCR MTb was 0.55 (95% CI 0.44–0.67). The overall sensitivity and specificity were 88% (95% CI 83–92) and 71% (95% CI 60–80), respectively. The pooled DOR was 12.15 (95% CI 5.55–26.62). The area under the SROC was 0.83. Conclusions: The diagnostic accuracy of PCR Mtb is not sufficient for use as a benchmark for ocular TB diagnosis routinely based on ATT response. A negative result may help avoid prescribing unnecessary ATT in dilemmatic cases.

Ocular tuberculosis is a serious disease with a long recurrent course, often leading to a significant decrease in the visual functions and quality of life of patients as well as disability. In recent years, the incidence rate of the ocular tuberculosis in the Russian Federation has been declining: in 2016, according to a number of authors, its incidence amounted to 5.2%.Purpose. To systematize literature data on the topic of ocular tuberculosis.Materials and methods. We reviewed literature available on elibrary.ru, cyberleninka.ru websites and in “Clinical Ophthalmology” journal. Results. We suggested classification of the ocular tuberculosis lesions, analyzed modern diagnostic methods and treatment regimens and evaluated their effectiveness.Conclusions. Literature review revealed that in order to improve the quality of detection, diagnosis and treatment of ocular tuberculosis, joint efforts of ophthalmologists and phthisiologists as well as use of modern methods of tuberculinodiagnosis are essential.

An otherwise healthy 72-year-old Chinese patient diagnosed with exudative age-related macular degeneration and decreased vision in left eye was fully investigated. The retrospective analysis of past multimodal imaging revealed bilateral severe choroidal neovascularization and choroiditis associated with a positive tuberculin skin testing and interferon-gamma release assay (QuantiFERON-TB Gold – Cellestis®, Chadstone, VIC, Australia) suggestive of latent ocular tuberculosis. The variable presentation and tests’ results interpretation represent the greatest limitations in understanding and treating intraocular TB (IOTB). This may present without any other systemic symptoms, the intraocular tissues are of limited access to biopsies and other tests, including imaging and immunological tests, are of relative value. This case highlights how variable may be the presentation of IOTB, which can be easily misdiagnosed leading to a delayed treatment and worse prognosis.

Topic An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis. Clinical relevance The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. Methods An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like choroiditis, tuberculoma, and tubercular focal or multifocal choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. Results Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular choroiditis. Experts agreed on initiating ATT in tubercular choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. Discussion Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.

Ocular tuberculosis (OTB) is an extrapulmonary mycobacterial infection, which still sees variations in incidence, manifestations, diagnostic and therapeutic approaches. While the disease is gaining more recognition as a differential in ocular inflammation, it remains a difficult entity to detect and treat. Global efforts to synthesize and standardize the approach to OTB could prove useful in delivering quicker, more effective care. We summarize recent insights in appropriate nomenclature, clinical presentations, diagnostic modalities and courses of treatment.

Tuberculosis (TB) is an airborne infection caused by Mycobacterium tuberculosis that usually affects the lungs. Timely treatment of active TB, diagnosis and prevention of latent TB are very important. However, extrapulmonary TB affects almost any tissues around the eye and orbit, and it then requires a high degree of suspicion to accurately diagnose. Diagnostic delays are common and may lead to morbidity. For ophthalmologists and infectious disease specialists, it is important to work together to accurately diagnose and treat ocular tuberculosis (OTB) to prevent vision loss. This review reports the latest advanced diagnostic methods for active TB and latent TB as well as various known manifestations of OTB. Important elements of diagnosis and treatment are also reviewed.

Ocular tuberculosis has protean clinical manifestations. Because of its varied clinical presentation, multimodal imaging is very important to characterize the disease activity, presence of inflammation, determining therapeutic response, and detection of complications.Narrative review.In this review, various imaging modalities employed in the management of ocular tuberculosis including fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) have been reviewed. Not only do these imaging tools complement each other in providing a comprehensive assessment of the pathology, they also help in gaining valuable insights regarding the evolution of the disease.Fundus imaging plays a vital role in the diagnosis and management of patients with posterior uveitis due to tuberculosis. Fundus imaging may have a useful role in defining clinical endpoints for ocular tuberculosis in the future.

To describe the presentation and management of atypical subretinal lesions following initiation of antitubercular therapy for a tubercular choroidal granuloma.An 18-year-old female was diagnosed with choroidal granuloma and shallow exudative retinal detachment in the left eye. Biopsy from a cervical lymph node was positive for tuberculosis. She was treated with antitubercular therapy (ATT) and oral steroids. After one week of therapy exudative detachment increased markedly and discrete yellowish-white subretinal lesions appeared first in the inferior periphery, then temporally and later involved the macula leading to a drop in visual acuity. A diagnosis of paradoxical worsening was considered and she was managed with a higher dose of oral corticosteroids, intravitreal methotrexate and intravitreal ranibizumab. The granuloma healed and the subretinal lesions as well as exudative detachment gradually resolved with improvement in visual acuity.Subretinal yellow-white lesions may develop as a paradoxical response to ATT.

A prospective clinical study to assess the utility of CD4 + T cell lymphocyte profiling from peripheral blood in patients with ocular tuberculosis (TB). Thirty-six Asian patients with presumed diag...

To investigate recurrence patterns following anti-tubercular therapy (ATT) in different anatomical presentations of ocular tuberculosis (OTB).Retrospective analysis of clinically diagnosed OTB patients divided anatomically into groups A (anterior + intermediate uveitis) and B (posterior + panuveitis). Recurrence was defined as reappearance of intraocular inflammation in a quiescent eye following completion of at least 6-months ATT. Anatomical sites of recurrence were compared to that of presentation.No significant difference in post-ATT recurrent inflammation was noted between groups A (14.29%, 4/28) and B (8.59%,11/128) (Anterior and intermediate uveitis, though uncommon at presentation, are relatively more common during post-ATT recurrences in OTB.

To report the clinical findings, anatomical features, and treatment outcomes in subjects with ocular tuberculosis (OTB) at 24 months in the Collaborative Ocular Tuberculosis Study (COTS)-1. Of the ...

Die tuberkulose Uveitis (TU) ist anfangs meist wenig akut, von geringen Sehstorungen begleitet und betrifft oft gesund wirkende jungere Patienten, sodass die Diagnose haufig primar verpasst wird. Ziel ist ein Update zu den therapeutischen Aspekten bei Verdacht auf TU. Anhand einer Literaturrecherche in PubMed zu den Stichworten wurden alle Studien, grosere Fallserien sowie Ubersichtsartikel der letzten 10 Jahre und darin zitierte Querverweise basierend auf der Expertise der Autoren ausgewertet. Wenn der Verdacht auf eine TU sich nicht erharten lasst, mussen Risiken und Nutzen der Therapie abgewogen werden. Das Ansprechen der Uveitis auf die antituberkulose Therapie (ATT) in 82 % ist ein wichtiger diagnostischer Hinweis. In Anbetracht dieser bemerkenswert guten Ansprechrate und vertretbarer Nebenwirkungen der ATT erscheint eine groszugige Indikationsstellung akzeptabel. Fehlendes Ansprechen oder eine paradoxe Verschlechterung der TU unter Therapie bei extrapulmonalen Tuberkulosemanifestationen sind vermutlich Ausdruck einer Hypersensitivitatsreaktion auf mykobakterielle Antigene und bedurfen einer zusatzlichen systemischen Steroidtherapie. Der Morbus Eales wird als vaskulitische Verlaufsform mit der TU assoziiert, spricht auf eine ATT nicht an und wird durch Lasertherapie der Ischamieareale behandelt. Eine TU tritt oft bei sonst gesunden Personen meist ohne extraokulare Manifestationen auf. Ein fruher Beginn der ATT moglichst vor einer systemischen Steroidtherapie ist entscheidend fur die langfristige funktionelle Erholung. Ein Therapieerfolg, definiert als Ausbleiben von Uveitisrezidiven innerhalb 6 Monaten nach Beendigung der Therapie ist damit in mindestens 82 % zu erwarten. Bei paradoxer Verschlechterung oder fehlendem Ansprechen ist zusatzlich eine Kontrolle der Entzundungsreaktion erforderlich.

Introduction: Management of ocular tuberculosis (OTB) poses a significant challenge due to heterogenous clinical presentations and persistent gaps in detection and treatment. The role of antituberc...

Serpiginous-like choroiditis is a rare manifestation of intraocular tuberculosis. It most often occurs in the context of suspected or latent tuberculosis. The diagnostic confirmation remains a real challenge. We report a case of a young patient presented with rapid bilateral visual acuity decrease. The diagnosis of tuberculous serpiginous-like choroiditis associated with mediastinal lymph node tuberculosis was established based on anamnestic, clinical, radiographic, and histological arguments. Anti-tuberculosis drugs have been recommended in combination with corticotherapy. The evolution was marked by significant stabilization of choroidal lesions with an improvement in visual acuity. Given its great clinical polymorphism, ocular tuberculosis should be suspected in any ocular inflammation, even atypical, in order to start early and appropriate treatment and improve the visual prognosis.

Ocular tuberculosis can manifest in a wide variety of clinical presentations. The prevalence is higher in endemic areas as a cause of granulomatous uveitis. While posterior segment manifestations are well known, anterior segment granulomas alone are relatively rare. We report two cases of unilateral iris granulomata in two young patients who presented with decreased vision and redness and were found to have well-circumscribed iris granulomas. Both underwent systemic evaluation and had a negative Mantoux test. Biopsy pathology of the lesions revealed granulomatous inflammation but were negative for PCR, staining, and culture for TB. One patient turned out to have multiple pulmonary lesions. The ocular condition initially worsened with steroid therapy alone and improved and resolved completely after starting a 9 months course of anti-tubercular therapy (ATT).

Ocular involvement is a rare manifestation of tuberculosis. Four key issues historically faced by clinicians when diagnosing and treating ocular tuberculosis - diagnostic uncertainty, naturally heterogeneous presentations, limitations of existing laboratory diagnostic tools, and non-uniform treatment guidelines - continue to test today's physicians. Unparalleled scientific and clinical developments over the past century have greatly expanded the knowledge surrounding this challenging ophthalmic condition. Experience with large volumes of cases at tuberculosis-endemic centres has led to recent growth in knowledge and physician experience, perhaps more so in developing countries. Looking forward, the role of diverse new technologies, including artificial intelligence and proteomics, will advance ocular tuberculosis research. Efforts have been made to address the lack of standardized nomenclature, diagnostic uncertainty, and unvalidated, geographically variable treatment guidelines.

The diagnosis of OTB (Ocular tuberculosis) is usually difficult to make. Definitive diagnosis requires the identification of M. tuberculosis organisms in ocular tissues or fluids, but samples are often difficult to obtain, and biopsy may be hard to justify. We describe a 50-years-old Maghreb male, who presented a multifocal choroiditis associated with a choroidal tuberculoma on the left eye. Based on positive QuantiFERON-TB-Gold test and suggestive clinical and radiographic findings, a diagnosis of presumed ocular tuberculosis was made. Serial swept-source optical coherence tomography (SS-OCT) and widefield fundus retinographies during subsequent follow-up visits demonstrated the characterization of the atypical tuberculosis presentation and allowed the assessment of response to antitubercular therapy and oral steroids.

We describe a case of right eye tubercular (TB) panuveitis with corneal involvement where repeated intraocular sampling was unsuccessful. Finally, evisceration and histopathology of ocular tissue confirmed the diagnosis of ocular tuberculosis. A chest X-ray showed signs of pulmonary TB. The patient was lost to follow-up but reported 2 months later with the right eyelid margin nodules with surface ulceration. Both eyelid and pulmonary lesions were resolved with anti-TB therapy.

Background Anterior cervical tuberculous abscess is a rare presentation of extrapulmonary tuberculosis even in endemic countries. Case presentation We report a case of a 14-year-old girl with a 5 day history of an anterior mass. The diagnosis of an infected fourth branchial cleft cyst was first evoked. Fine-needle aspiration cytology was suggestive of tuberculosis. Polymerase chain reaction analysis was the key to the diagnosis of a tuberculous abscess. Conclusions In endemic countries, abscesses occurring in uncommon sites should be dealt with a high degree of suspicion for tuberculosis. Early diagnosis is essential to initiate specific and effective treatment. Pre-operative diagnosis avoids invasive surgery and related complications.

Ocular tuberculosis (OTB) is a rare form of extrapulmonary Tuberculosis (EPTB) and a rare presenting feature of tuberculosis (TB) in children. We report such a case in a 3-year-old boy who presented with a painless swelling over left upper eyelid. Mycobacterium tuberculosis bacilli were isolated from the swelling by a Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis. Investigating him for the extent of disease, we found him to have intracranial extension to involve the ethmoid sinus on contrast enhance Computed Tomography and Pott's disease causing a compression fracture of L3 with bilateral paravertebral collection, epidural extension and a left psoas abscess on Magnetic Resonance Imaging. After starting antitubercular therapy, the child is doing well and on regular follow up. We are presenting this case to highlight the fact that extensive spinal tuberculosis can present without any neurological deficit and may even present only as a benign looking orbital swelling.

Ocular tuberculosis (OTB) in patients with human immunodeficiency virus (HIV) commonly presents as choroidal tubercles or granuloma. We report a rare presentation of OTB with hypopyon granulomatous uveitis in a patient with HIV on highly active antiretroviral therapy (HAART). Aqueous humor polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis (MTB). Antitubercular therapy (ATT) was initiated despite which it progressed to scleral abscess and panophthalmitis. Enucleation with ball implantation was done. Histopathology revealed caseating granuloma with numerous acid-fast bacilli (AFB) and real-time PCR showed increased copies of MTB genome. After a full course of ATT, he had stable ocular and systemic condition at final follow-up.

Objectives: Ocular tuberculosis is an extrapulmonary tuberculous infection and has varying manifestations which pose a huge challenge to diagnosis and treatment. The purpose of this study is to describe the various clinical manifestations of ocular inflammations due to tuberculosis and to assess the response to treatment following antituberculous therapy (ATT) and corticosteroids in these patients. Materials and Methods: We performed a retrospective analysis of 29 patients with presumed ocular tuberculosis who were started on ATT and completed follow-up of at least 6 months after ATT was initiated. The data collected were: age at presentation, sex, laterality, presence or absence of pulmonary/extrapulmonary tuberculosis, history of exposure to tuberculosis, site of ocular involvement and duration of illness, visual acuity at presentation and at 6-month follow-up, and response to treatment. Results: Most of the patients were of economically productive age, between 21-60 years. This most common presentation in our study population was unilateral nongranulomatous anterior uveitis. In spite of the delay between symptom onset and start of therapy, favorable response was noted in 79.3% of patients at completion of 6 months of ATT. The various reasons for the delay in start of therapy were also evaluated. Conclusion: In this case series, we presented the various ocular manifestations and the difficulties faced in the diagnosis of presumed ocular tuberculosis. Outcomes of ATT were favorable in most of our patients. Thus, the clinician should exercise a very high degree of suspicion and should not withhold a trial of ATT.

A 6-year old girl, presented with symptoms of obstructive sleep apnoea. She was referred to our centre when she developed obstructive symptoms such as stridor and dysphagia a month later. She was found to have a right neck swelling with a posterior pharyngeal wall mass, which caused upper airway obstruction. A computerized-tomography scan of her neck showed a very narrowed upper airway with a retropharyngeal abscess without prevertebral or vertebral involvement. She had a challenging intubation and underwent an emergency intraoral incision and drainage. Pus that was drained revealed acid fast bacilli and histopathological examination showed necrotizing granulomatous inflammation, in favour of a tuberculous abscess. Post operatively, her symptoms resolved and her intraoral wound healed. She completed anti-tuberculous treatment and has remained well at 6 months follow up. Our case illustrates how a cold retropharyngeal abscess can masquerade as obstructive sleep apnoea, with a compromised airway as it increases in size.

Ocular tuberculosis is an exigent clinical entity—lacking a distinct clinical presentation and attributing the diagnostic conundrum. Nevertheless, the early-precise diagnosis with implicated anti-tubercular therapy may be sight-saving; diagnostic delays often encountered due to protean clinical presentations, the impracticability of obtaining tissue (in most case), limitation on sample volume extraction, and of wanting a sensitive diagnostic test. This article revises the current scenario of ocular tuberculosis, its clinicopathologic arrays, and diagnostic challenges for clinical management; Furthermore, advocates for compiling all such positive findings of corroborative tests in a precise diagnosis.

Background: Ocular tuberculosis can have protean manifestations. Anti-tubercular therapy (ATT) and oral steroids are employed in the management of this condition. There is evidence in the literature which has highlighted the use of intravitreal anti-vascular endothelial growth factor drugs as an adjunct to systemic therapy.Report of the Case: A 44-year-old male presented with a decrease of vision in the right eye was diagnosed choroidal tuberculoma with massive exudation and subretinal fluid. The patient was treated with intravitreal ranibizumab injection. The lesion regressed completely within 6 weeks without any additional systemic corticosteroids and ATT without any recurrence over 6 months during follow-up.Conclusions: Ranibizumab monotherapy may lead in complete regression of vascularized tubercular choroidal granulomas without the need of adjunctive ATT and corticosteroids. After intravitreal injection of ranibizumab, the lesion may be observed for regression over several weeks.

Purpose: To describe the approach of Brazilian specialists in the diagnosis and treatment of tuberculosis-associated uveitis (TBU).Methods: Members of the Brazilian Uveitis Society received an elec...

This case series aims to discuss cases of bilateral optic neuritis secondary to presumed ocular tuberculosis (TB) in two immunocompetent adults. Ocular TB has been associated with optic neuritis, but bilateral cases in immunocompetent individuals are rarely seen. We report a case series of two young healthy adults with bilateral painless optic neuritis as the presenting feature of ocular TB. Clinical examination, TB tests, and angiographic studies supported the diagnosis. All patients were started on anti-TB medication followed by oral prednisolone and had visual improvement a few weeks after treatment. As a conclusion, these cases highlight an atypical case of ocular TB presentation in immunocompetent individuals and thorough investigation is pertinent to preserve the visual function.

Choroidal tuberculoma is a solitary elevated choroidal mass-like lesion regarded often characteristic of intraocular tuberculosis. Serial swept-source optical coherence tomography (SS-OCT) is a very important tool in monitoring the course of choroidal tuberculoma and allows in early detection of complications such as choroidal neovascular membrane (CNVM). We describe a 26-year-old young Indian female, who presented with a solitary choroidal mass lesion in the left eye. Based on positive Mantoux test, biopsy of cervical lymph nodes showing acid-fast bacilli and radiographic findings, a diagnosis of choroidal tuberculoma was made. Serial SS-OCT during subsequent follow-up visits up to 14 months demonstrated the characterization of the lesion and assessment of response to antitubercular therapy and oral steroid. The patient was subsequently diagnosed to have concurrent CNVM and successfully treated with two anti-vascular endothelial growth factor intravitreal injections.

Background Bovine tuberculosis is a chronic inflammatory disease that causes granuloma formation mainly in retropharyngeal, tracheobronchial, mediastinal lymph nodes and lungs of bovines. The presence of these lesions in other tissues such as the eyeball is very rare and difficult to diagnose. This study describes macroscopic and microscopic pathological findings in a calf with ocular and meningeal tuberculosis. Case presentation March 2019, an eight-month-old Holstein Friesian calf was identified in a dairy farm located in central Mexico with a clinical cough, anorexia, incoordination, corneal opacity and vision loss. At necropsy, pneumonia, lymphadenitis, meningitis, and granulomatous iridocyclitis were observed. The histopathological examination revealed granulomatous lesions in lung tissue, lymph nodes, meninges and eyes with the presence of acid-fast bacilli associated with Mycobacterium spp. Conclusion To the best of our knowledge, this is the first report that describes macroscopic and microscopic pathological findings of ocular tuberculosis in cattle. This report highlights the importance of considering bovine tuberculosis in the differential diagnosis of corneal opacity and loss of vision in cattle.

Purpose: To report a case of bilateral ocular tuberculosis (OTB) in a child with negative Tuberculin skin test (TST).Methods: Case report.Observations: A 12-year-old malnourished systemically asymptomatic boy presented with sudden profound loss of vision in both eyes. Dense vitritis precluded fundus visualization in right eye (RE). In left eye, fundus findings of extensive vasculitis associated with multifocal retinochoroiditis were suggestive of OTB. However, negative TST, normal chest X-ray, and gram negative bacteriuria led to confusion between endogenous endophthalmitis and OTB. Based on strong clinical suspicion and high-resolution chest tomography (HRCT) of thorax which was suggestive of TB-pneumonitis, a diagnosis of presumed OTB was made. A good response to anti-tubercular-treatment and corticosteroids, with resolution of retinochoroiditis lesions, vasculitis, and vitritis, further supported our diagnosis.Conclusions: This case highlights the importance of keeping a high index of suspicion for TB-associated uveitis in children, based on clinical findings.

Purpose: This study presents clinical features and prognosis after long-term (12–18 months) antitubercular therapy (ATT) in patients with ocular tuberculosis (OTB) in East China, an endemic area of...

AimsFew studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate the value of the QuantiFERON test in a large cohort of patients with uveitis for both the diagnosis of tubercular uveitis and antituberculosis treatment (ATT) response prediction.MethodsA single-centre retrospective study including consecutive adult patients with uveitis who were prescribed a QuantiFERON test between January 2003 and December 2019 was performed. Adjusted ORs (aORs) were calculated between patients with uveitis responding and not responding to ATT according to the Collaborative Ocular Tuberculosis Study (COTS) group diagnostic criteria. Sensitivity (SE), specificity (Sp), and positive and negative predictive values of the QuantiFERON test were calculated.ResultsA total of 1075 patients were included in the study; 178 (16.5%) were found positive using the QuantiFERON test. Among the 178 positive patients, 62 (35%) had a diagnosis of tubercular uveitis according to the updated COTS classification; all received ATT for 6 months; and 44/62 (71%) responded to ATT. A QuantiFERON test value of >2 IU/mL was associated with a greater chance of responding to ATT (aOR=36.7, 95% CI 7.2 to 185.9, pConclusionOne-sixth of the patients diagnosed with uveitis had a positive QuantiFERON test. The QuantiFERON threshold with the optimal SE and Sp for the diagnosis of tubercular uveitis was 4 IU/mL.Trial registration numberNCT03863782.

RESUMO Os tuberculomas de coroide apresentam-se em pacientes com tuberculose ocular. Geralmente, ocorrem em individuos com historia previa de tuberculose e raramente tem apresentacao inicial sem manifestacoes sistemicas anteriores. Relatamos o caso de um paciente com tuberculoma de coroide unilateral com apresentacao inicial de tuberculose ocular presumida, permitindo o inicio mais precoce do tratamento. Tuberculoma coroidal unilateral como manifestacao inicial de tuberculose ocular presumida: relato de caso