SHM Converge Scientific Abstract ePoster Gallery-Ocular Tuberculosis? A Diagnostic Challenge in a Case of Unilateral Retinitis

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This case report describes a 48-year-old man from Guatemala who presented with one week of painless, unilateral left vision loss. Eye examination showed optic disc edema, retinal edema, flame hemorrhages, Paton’s lines, and an early macular star, consistent with neuroretinitis. Initial infectious workup for common causes was negative, including Bartonella, Brucella, HIV, syphilis, toxoplasma, and toxocara. MRI of the brain showed no optic nerve enhancement, and chest X-ray revealed multiple calcified granulomas suggestive of prior granulomatous disease. His QuantiFERON-TB Gold test was positive.<br /><br />Given the patient’s epidemiologic TB risk factors, positive TB screening, ocular findings, and exclusion of other causes, he was diagnosed with suspected ocular tuberculosis presenting as unilateral neuroretinitis. He was started on standard RIPE therapy (rifampin, isoniazid, pyrazinamide, and ethambutol), with a planned continuation phase of rifampin and isoniazid for at least four additional months.<br /><br />At five-month follow-up, his optic disc edema had resolved and his visual acuity improved to 20/160, demonstrating partial response to treatment.<br /><br />The report emphasizes that ocular tuberculosis is an uncommon extrapulmonary manifestation of TB and may occur without pulmonary disease. TB neuroretinitis is especially rare. Diagnosis is often clinical, based on ocular findings plus epidemiologic exposure and supportive testing, because ocular tissue sampling is rarely performed due to low yield and procedural risk. Prompt recognition and treatment are important to prevent irreversible vision loss, as ocular TB can resolve slowly and may cause permanent impairment if therapy is delayed.

Asset Subtitle

Preeya B. Bhakta

Meta Tag

Author List Eva Clark, Foroozan Rod, Lee Lu, Preeya B. Bhakta

Category Clinical Vignettes

Concept Ocular Tuberculosis

Concept Neuroretinitis

Concept Vision Loss

Concept Optic Disc Edema

Concept RIPE Therapy

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Preeya B. Bhakta

Track Adult

Keywords

ocular tuberculosis

neuroretinitis

unilateral vision loss

optic disc edema

RIPE therapy

QuantiFERON-TB Gold

calcified granulomas

extrapulmonary tuberculosis

macular star

visual acuity improvement

Ocular Tuberculosis

Neuroretinitis

Vision Loss

Optic Disc Edema

RIPE Therapy