SHM Converge Scientific Abstract ePoster Gallery-The Eyes Are Windows to the Lungs: A Case of Ocular Tuberculosis Uncovering Tuberculous Pulmonary Disease and Other Mycobacterial Species

The Eyes Are Windows to the Lungs: A Case of Ocular Tuberculosis Uncovering Tuberculous Pulmonary Disease and Other Mycobacterial Species

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This case report describes a 62-year-old man whose eye symptoms led to the discovery of pulmonary tuberculosis. During a 90-day trip to Nicaragua, he developed floaters, flashes, and visual disturbances and was first diagnosed with posterior uveitis. After returning to the United States, he was found to have bilateral panuveitis and vasculitis. An extensive uveitis workup was negative except for a strongly positive QuantiFERON-TB test.<br /><br />Further history revealed chronic cough, night sweats, and weight loss. Chest imaging showed a left upper lobe infiltrate and a cavitary pleural-based consolidation, raising concern for active tuberculosis. He was started on RIPE therapy (rifampin, isoniazid, pyrazinamide, ethambutol) plus vitamin B6, along with oral and ocular steroids. MTB PCR from sputum was negative, but later cultures grew Mycobacterium abscessus in one sample and Mycobacterium gordonae in another, highlighting that not all mycobacterial isolates necessarily represent the cause of disease.<br /><br />The discussion emphasizes that ocular tuberculosis is rare, difficult to diagnose, and may occur alone or alongside pulmonary TB. Uveitis can be anterior, posterior, or panuveitis, and delayed treatment risks permanent vision loss. Because ocular samples are often hard to obtain, diagnosis relies heavily on clinical suspicion, travel/exposure history, imaging, and supportive testing. The authors note that TB-associated uveitis may be due either to direct infection or an immune-mediated hypersensitivity response. They also stress that RIPE therapy and systemic steroids are recommended promptly to reduce inflammation and prevent complications.<br /><br />Overall, this case illustrates that ocular findings can uncover occult pulmonary TB and that a broad differential is essential when evaluating uveitis.

Asset Subtitle

Abdulah Barakat

Meta Tag

Author List Abdulah Barakat, Anthony Cannella, David Kornblum, Richard Lawrence Oehler, Sandra Gompf, Vivian Vega Rodriguez

Category Clinical Vignettes

Concept Ocular Tuberculosis

Concept RIPE Therapy

Concept Uveitis

Concept Broad Uveitis Workup

Concept Nontuberculous mycobacteria

Distinguished Non-Finalist

Presenter Organization University of South Florida

Presenting Author Abdulah Barakat

Track Adult

Keywords

ocular tuberculosis

uveitis

panuveitis

pulmonary tuberculosis

QuantiFERON-TB

RIPE therapy

Mycobacterium abscessus

Mycobacterium gordonae

vasculitis

vision loss

Ocular Tuberculosis

RIPE Therapy

Uveitis

Broad Uveitis Workup

Nontuberculous mycobacteria