SHM Converge Scientific Abstract ePoster Gallery-Ocular Tuberculosis: An Eye-Opening Sight

Pdf Summary

This case report describes a 65-year-old Vietnamese man who presented with blurry vision and was found to have a right-eye scleral defect with uveal prolapse, consistent with scleromalacia perforans (anterior necrotizing scleritis without inflammation). He also had months of floaters, worsening vision, and photophobia, along with systemic symptoms including weight loss, headaches, night sweats, nausea, and vomiting.<br /><br />Although his initial infectious, autoimmune, and CSF workup was largely negative, imaging revealed widespread disease: MRI showed numerous ring-enhancing brain lesions with vasogenic edema, CT chest showed a miliary lung pattern with mediastinal lymphadenopathy, and CT abdomen/pelvis showed liver calcifications consistent with granulomatous disease. His history of immigration from a TB-endemic country and prior BCG vaccination increased suspicion for tuberculosis despite a negative QuantiFERON test.<br /><br />Ocular tuberculosis is rare in the United States, accounting for only 1–2% of TB cases, but it can affect nearly any ocular structure and is often difficult to diagnose. In this patient, the eye findings were the first major clue to disseminated TB. The report emphasizes that TB-related scleritis, especially scleromalacia perforans, can occur through delayed hypersensitivity reactions and may present without obvious inflammation.<br /><br />He was treated empirically with standard RIPE therapy: rifampin, isoniazid, pyrazinamide, and ethambutol. After eight weeks, his symptoms completely resolved.<br /><br />The key lesson is that ocular TB should be considered in patients with unexplained eye disease and relevant epidemiologic or systemic risk factors, even when initial tests are negative. Early recognition and treatment are critical to preserving vision and preventing serious complications.

Asset Subtitle

Aana Amin

Meta Tag

Author List Aana Amin, Adrienne Atencio

Category Clinical Vignettes

Concept Ocular Tuberculosis

Concept Scleromalacia Perforans

Concept Tuberculosis

Concept RIPE Therapy

Concept Extrapulmonary Tuberculosis

Distinguished Non-Finalist

Presenter Organization University of California, Davis - School of Medicine

Presenting Author Aana Amin

Track Adult

Keywords

ocular tuberculosis

scleromalacia perforans

anterior necrotizing scleritis

uveal prolapse

disseminated tuberculosis

ring-enhancing brain lesions

miliary lung pattern

granulomatous disease

RIPE therapy

vision loss

Ocular Tuberculosis

Scleromalacia Perforans

Tuberculosis

RIPE Therapy

Extrapulmonary Tuberculosis