Tubercular panophthalmitis in a patient with human immunodeficiency virus infection: Proven clinicopathologically and by molecular diagnostic tests

Abstract

Ocular tuberculosis (OTB) in patients with human immunodeficiency virus (HIV) commonly presents as choroidal tubercles or granuloma. We report a rare presentation of OTB with hypopyon granulomatous uveitis in a patient with HIV on highly active antiretroviral therapy (HAART). Aqueous humor polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis (MTB). Antitubercular therapy (ATT) was initiated despite which it progressed to scleral abscess and panophthalmitis. Enucleation with ball implantation was done. Histopathology revealed caseating granuloma with numerous acid-fast bacilli (AFB) and real-time PCR showed increased copies of MTB genome. After a full course of ATT, he had stable ocular and systemic condition at final follow-up.

Commentary: A challenge of paradoxical worsening and immune reconstitution uveitis

“…In the context of TB-IRU, authors[ 6 ] have presented a striking case of chronic ocular tuberculosis with granulomatous panuveitis progressing to panophthalmitis. The index case was on HAART for 1 year until presentation, and CD4 count 1 month before antitubercular therapy (ATT) initiation was 324.…”