Latent tuberculosis-related scleritis: a case report

Abstract

BackgroundScleritis is a painful inflammatory process centered in the sclera that may involve the cornea and the underlying uvea. The etiology is commonly idiopathic or autoimmune but some cases are associated with systemic infection such as tuberculosis.Case presentationIn this report, we describe an unusual case of a female Moroccan patient who had a long history of bilateral recurrent scleritis associated with peripheral keratopathy and anterior uveitis. The patient was diagnosed with latent tuberculosis and responded to antitubercular therapy administrated after exclusion of other aetiologies. This patient was finally diagnosed with latent tuberculosis- related scleritis.ConclusionsAlthough systemic tuberculosis is reported as a possible cause of scleritis and other ocular inflammatory manifestations, assessment of the diagnosis of tuberculosis-related ocular inflammation is challenging especially in latent forms. The treatment is largely presumptive. However, a favorable response to antitubercular therapy without relapse is taken as evidence of the disease.

An OCT Study of Anterior Nodular Episcleritis and Scleritis

“…This is in accordance with the existing assumption that favorable response to antituberculosis chemotherapy may serve as indirect evidence of disease [13]. …”

Tuberculous Posterior Sclero-Uveitis with Features of Vogt-Koyanagi-Harada Uveitis: An Unusual Case

“…Moreover, this particular presentation was accompanied by posterior scleritis, which has already been reported in ocular tuberculosis [24], but in our case contributed to a more complicated presentation of the disease. Serpiginous-like TB uveitis is considered to be a common presentation of tuberculous ocular infection, but there are no previous reports of VKH-like ocular disease.…”

Frequently Relapsing Anterior Nodular Scleritis as the Initial Presentation of a Lethal Systemic Infection: Disseminated Tuberculosis with HIV Coinfection

“…e exact pathogenesis of TB scleritis is still in debate. Hematogenous spread from the lungs is considered to be the commonest mechanism by which TB affects eyes, but spread via direct local extension is considered to be rare [2,5,7]. Diagnosis of TB scleritis is challenging specially in endemic setting and nonspecific tests such as the tuberculin skin tests, and interferon-gamma release assays are widely used and considered useful diagnostic tools.…”

“…Since these cannot differentiate between the latent form and active disease, the utility of these tests become limited in the endemic areas [7]. Like any other infectious disease, the definitive diagnosis of TB scleritis is to demonstrate mycobacterium TB in scleral samples by culture or detection of acid-fast bacilli (AFB) in smears [2,7]. Obtaining ocular samples is invasive and is frequently associated with serious complications such as keratitis, cataract, and even permanent blindness [2,9,14,15].…”

“…Scleritis is a common disease in ophthalmology where more than 50% of the patients are found to have an underlying systemic illness [1][2][3][4]. e incidence of infectious aetiology in scleritis is considered to be less than 10% [1,2,4]. Tuberculosis represents only about 10.6% of all infectious scleritis [5].…”