Título

OCULAR TUBERCULOSIS ASSOCIATED WITH NEURORRETINITIS IN ADULT: CASE REPORT

Objetivo

Describe and discuss retinal alterations caused by Mycobacterium tuberculosis and its rare extrapulmonary features.

Relato do Caso

Female, 37 yo, presenting with low visual acuity in the right eye for 8 days, associated with conjunctival hyperemia and ocular pain. Nothing on hers past medical history nor ocular diseases.
BCVA: OD: <20/400; OS: 20/25
Biomicroscopy: OD: keratic precipitates, anterior chamber cells +2/+4, normal pupillary reflex. OS: unremarkable.
IOP: 17/16mmHg
Fundoscopy: OD: irregular optic nerve, papillary edema, macula star, serous detachment and vitreitis +1/+4. OS: superior and nasal irregular optic nerve.
Hypothesis: Ocular Bartonellosis?
Treatment with Doxaciclin 12/12h + Prednisone 60mg/day + Prednisolone 1% eye drops every 3h was started. Requestes infeccious diseases serologies, including TB test and Xray.
Follow up: IGRA test: + / other infeccious diseases: negative. Suspended Doxiciclin and referred to primary care facility to start antituberculosis therapy. After 2 weeks with new treatment, referred visual acuity improvement (BCVA OD: 20/60).

Conclusão

According to the World Health Organization (WHO), TB is onde of the top ten causes of death worldwide and the leading cause of death from a single infectious agent, with one-third of the world's population infected with Mycobacterium tuberculosis (MTB), and thus at risk of developing the disease. Ocular TB (OTB) is a rare extrapulmonary form of the disease, not to be underestimated considering its potencial impact on visual loss in patients diagnosed with the disease. OTB still represents a major diagnostic and therapeutic challenge, due to its heterogeneous clinical manifestations, mixed ocular tissue involvement, lack of diagnostic criteria and gold standard tests, and lack of international agreement on the therapeutic approach.