1Weich C.-M., 2Müller-Molaian I., 1Palmowski A., 2Remberger K., 1Ruprecht K. W.

1Universitäts-Augenklinik, 2Institut für Pathologie der Universitätskliniken des Saarlandes, Kirrbergerstr.1,D-66424 Homburg

Objective: The clinical course of ocular organic tuberculosis is presented in a 51 year old nurse working in a nursing home.
Patient and method: In November 1998 the patient presented at our clinic with a one year history of recurrent scleritis of the right eye. Previous Tinetests had been negative. Ophthalmologic examination revealed a mixed conjunctival injection as well as cells in the anterior chamber and vitreous without signs of retinitis. Treatment with local and systemic steroids lead to a transient recovery only. A continuous worsening resulted in a necrotizing scleritis in August 2000. Biopsy showed a florid and chronic epitheloidcellular-granulomatous inflammation without evidence of specific causative agents. At this time the Tine-test was highly positive. A PCRexamination was performed which yielded a genetic sequence typical for Tbc. Systemic tuberculosis was excluded. Due to incompatibilities, tuberculostatic therapy had to be reduced to a single line treatment with Rifampicin. In January 2001, a continuous severe worsening of the findings necessitated enucleation of the right eye. Histopathologic examination showed a pronounced florid chronic scleritis, uveitis and retinitis without evidence of granulomas typical for tuberculosis. However, the PCRexamination yielded a genetic sequence specific for Tbc. So far the patient has been on Rifampicin therapy without complaints.
Conclusion: Besides histopathology, PCR is recommended to prove or exclude rare ocular organic tuberculosis in scleritis of unknown etiology.

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