Tuberculous Scleritis in a Patient with Rheumatoid Arthritis

Biswas, Jyotirmay; Aparna, A C; Annamalai, Radha; Vaijayanthi, K.; Bagyalakshmi, R

doi:10.3109/09273948.2011.628195

Cited by 18 publications

(9 citation statements)

References 12 publications

(11 reference statements)

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“…[8] In cases of scleritis following trauma where infection is suspected but routine microbial culture is negative, polymerase chain reaction tests may be used to confirm the diagnosis. [9] If these tests are also negative, the possible diagnosis of surgically induced necrotizing scleritis (SINS) should be considered. SINS is a believed to be a delayed-type hypersensitivity response to any form of surgical trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Some presented with scleritis and developed secondary intraocular spread, which has been described in other reports. [91112] Others had scleritis, uveitis, and endophthalmitis at presentation (e.g., Case 7 where the sclera in the area of the bleb was necrotic with vitreous inflammation). The wide use of anti-metabolites at the time of trabeculectomy increases risk of scleral melt and inflammation, which may have resulted in secondary infection and endophthalmitis.…”

Section: Discussionmentioning

confidence: 99%

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Infectious scleritis: Clinical spectrum and management outcomes in India

Pradhan

Jacob

2013

Indian J Ophthalmol

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In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small-incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Infectious scleritis: Clinical spectrum and management outcomes in India

Pradhan

Jacob

2013

Indian J Ophthalmol

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“…As in other forms of ocular TB, the diagnosis of tuberculous scleritis is frequently presumptive. In rare instances the diagnosis can be confirmed by histopathology or PCR following enucleation [9]. In a case-control study, anterior uveitis with extensive posterior synechiae or scleritis was more likely to be found in patients with presumed latent TB-associated uveitis than control uveitis cases [10].…”

Section: Tuberculosis As An Ocular Masqueradementioning

confidence: 98%

Update on ocular tuberculosis

Yeh

Sen

Colyer³

et al. 2012

Current Opinion in Ophthalmology

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The diagnosis of presumed ocular tuberculosis remains a clinical challenge with currently available diagnostic modalities. Although newer interferon-γ release assays can distinguish exposure to M. tuberculosis from the Bacille-Calmette-Guérin vaccine strain, they currently lack the specificity to distinguish between latent tuberculosis infection and active tuberculosis. Continued improvement in the currently available molecular diagnostic techniques including quantitative PCR may be valuable in our ability to establish an earlier etiologic diagnosis and institute appropriate antimycobacterial therapy.

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“…Another report has previously emphasized the clinical suspicion of tuberculosis in cases of scleritis unresponsive to anti-inflammatory medications [8]. In the present case the positive Quantiferon assay [9] along with patient origin from a country of high prevalence [10] raised the clinical suspicion of tuberculosis.…”

Section: Discussionmentioning

confidence: 51%