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Impressum
Retinal vasculitis as monosymptomatic extrapulmonary manifestation of tuberculosis
Krist D., Wenkel H.
Department of Ophthalmology, University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen
Objective: Nowadays ocular tuberculosis is rather uncommon and
accounts for only 0.5% of patients with extrapulmonary tuberculosis. We
report on a patient with retinal vasculitis as only symptom of extrapulmonary
tuberculosis.
Patient: A 29-year old male patient presented with bilateral blurred
vision (OD 20/50, OS 20/40) associated with ocular pain and redness. There
was a history of recurrent iridocyclitis for several years with rapid
relapses after initial response to treatment with topical steroids. Prior
diagnostic work up had not led to a specific diagnosis. The general medical
history was unremarkable. Both eyes showed mild flare in the anterior
chamber and ophthalmoscopy revealed perivascular shedding of retinal vessels
with mild vitreitis. There were no choroidal changes detectable. The inflammation
was refractive to treatment with topical steroids.
Results: Intensive questioning revealed repeated contact to persons
with active pulmonary tuberculosis correlated to the onset of iridocyclitis.
No other cause for uveitis could be identified. Tuberculin skin test was
positive. Chest X-ray, sputum samples, and gastric aspirate were uneventful.
Triple antituberculous therapy resulted in rapid regression of ocular
inflammation. Visual acuity increased to 20/25 on both eyes. So far no
recurrences have been observed.
Conclusions: Without systemic signs the definite diagnosis of tuberculous
uveitis is certainly problematic. However, the history of recurrent iridocyclitis
after exposure to tuberculosis, the positive skin test, and a dramatic
improvement after antituberculous therapy suggest an association of retinal
vasculitis and tuberculosis in our patient. Ocular inflammation may be
either induced by direct bacterial infection or by an hyperergic response
to mycobacterium tuberculosis. Ocular tuberculosis should even be considered
in atypical cases without systemic changes or common ocular features like
disseminated choroiditis.