<p>Endogenous Tuberculous Endophthalmitis and Panophthalmitis: A Systematic Review of Case Reports and Case Series</p>

Abstract

To systematically review the characteristics of patients with endogenous tuberculous (TB) endophthalmitis and panophthalmitis in an effort to help clinicians with diagnosis and treatment. Patients and Methods: We conducted a systematic literature search in MEDLINE/ PubMed, EMBASE and Web of Science from inception to August 2020. References and abstracts were screened independently by two authors. Included studies were case reports and case series reporting endogenous TB endophthalmitis and panophthalmitis secondary to Mycobacterium tuberculosis complex (MTBC). Available-case analysis was employed to handle missing data. Results: A total of 1343 articles were found using the search strategy. Following abstract screening, 51 articles were selected for full text-review, from which 26 were deemed eligible for inclusion in the study. Forty-four cases from 26 articles were included in the quantitative analysis. The median age of presentation was 29.5 (range: 1 to 81), and 11/44 patients (25.0%) were pediatric. Immunosuppression was seen in 9/36 cases (25.0%). Most patients (24/38, 63.2%) had no prior history of tuberculosis. Systemic symptoms were absent in half of the patients (16/32, 50.0%). Visual acuity was poor, with 23/27 cases (85.2%) being 20/ 200 or worse at presentation. Poor organ and visual outcomes were reported: 36/43 cases (83.7%) resulted in enucleation/evisceration or exenteration. Intraocular tumors were suspected in 5/34 cases (14.7%). Pulmonary tuberculosis was seen in 15/35 cases (42.8%), and miliary tuberculosis was seen in 7/35 cases (20.0%). The earliest source of TB diagnosis was through histopathologic specimen after eye removal in 32/44 cases (72.7%), vitreous specimen in 6/44 cases (13.6%) and aqueous specimen in 3/44 cases (6.8%). Conclusion: TB endophthalmitis is a rare and sight-threatening manifestation of ocular tuberculosis. It can occur in apparently healthy individuals and can mimic intraocular tumors and other infectious etiologies. Diagnosis remains a significant challenge, which, often delayed, leads to profound visual loss. Early detection and treatment of intraocular tuberculosis may be associated with better ocular and systemic outcomes.

Disseminated tuberculosis involving the eye, skin, axillary lymph nodes and lungs in an immunocompetent host

“…Throughout the treatment period, the patient was closely monitored to assess the patient’s response and for any adverse effects of the drugs. While disseminated TB typically has a poor visual outcome, the patient showed encouraging signs of progress as their lymphadenopathy and skin lesions resolved after receiving treatment 4…”

“…Choroidal tubercles are the most commonly observed finding in patients with intraocular TB 2 3. Intraocular TB predominantly affects immunocompetent individuals, the majority whom have poor visual acuity (20/200 or worse) at presentation and tend to have unfavourable outcomes, often necessitating enucleation/evisceration or exenteration of the affected eye 4…”

Clinical Profile and Treatment Outcome of Endogenous Endophthalmitis

“…In most cases, the diagnosis is made on histopathology after enucleation of the affected eye. 22 Pediatric EE accounts for 0.1% to 4% of all cases of EE. The highest number of patients recorded are from India and the lowest from the USA.…”

Reply to: differential diagnosis of pseudohypopyon and discussion of extranodal natural killer/T-cell lymphoma presenting as hypopyon panuveitis

“…Next, Dr. Evereklioglu brought up a point about “uninjected white eye”, and he proposed that this should be used to exclude an infectious etiology of ocular inflammation. We think this is partially correct, and we are not opposing that subtle conjunctival injection is a clue to diagnose ocular masquerade syndrome, but we also raise the point that some patients with infectious uveitis may also present with mild conjunctival injection [ 6 – 8 ]. In addition, we did not mention the prior treatment of our patient in the article.…”