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A.A. Kuzin, A.A. Fawzi, T.M. O'Hearn, D.L. Yu, H.S. Reddy, J.I. Lim; A Recent Resurgence of Ocular Tuberculosis with Unusual Posterior Segment Manifestations . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1909.
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Ocular tuberculosis (TB) presents with a myriad of clinical manifestations that mimic other conditions, often leading to misdiagnosis and delay in treatment. We describe a series of immunocompetent patients, who presented a special diagnostic challenge due to unusual posterior segment findings of ocular TB.
Retrospective chart review was performed to examine all cases of ocular TB with posterior segment findings seen over a 6 month time period in 2005 in a tertiary hospital in Los Angeles, California. We analyzed the clinical findings, method of diagnosis, and clinical course for a series of five cases of ocular TB. All patients with isolated anterior segment findings were excluded.
Five patients were diagnosed with posterior segment manifestations of TB, their ages ranged from 38–61. Clinical manifestations included retinal vasculitis (n=2), chorioretinal lesion (n=2), cystoid macular edema (n=1), optic neuritis (n=1), branch retinal vein occlusion (n=1). Diagnostic methods included positive PPD (n=4), anterior chamber polymerase chain reaction (PCR) (n=1), chorioretinal biopsy and PCR (n=1). All chest x–rays were negative for active TB. All patients were immunocompetent. The patients were initially diagnosed with choroidal tumor (n=1), Toxoplasmosis (n=1), idiopathic retinal vasculitis (n=1), and one patient received an extensive hematologic workup for presumed bilateral vein occlusion in a young age. Visual acuity at presentation ranged from 20/70 to 20/400. One case was bilateral, while four were unilateral. Four patients were placed on anti–TB treatment. Two showed complete remission with vision improving to 20/25, two showed a partial response, and one was lost to follow–up.
In patients where suspicion of TB is raised, especially in the face of lack of systemic evidence of TB, anterior chamber paracentesis or biopsy for PCR can be helpful in confirming the diagnosis of ocular tuberculosis, as in two of our patients. Finally, once ocular TB is recognized, prompt systemic treatment should be initiated, as visual outcomes can be excellent.
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