Asunto(s)
Ceguera/etiología , Granulomatosis con Poliangitis/diagnóstico , Enfermedades Pulmonares/diagnóstico , Panoftalmitis/complicaciones , Escleritis/complicaciones , Agudeza Visual , Percepción Visual/fisiología , Ceguera/diagnóstico , Ceguera/fisiopatología , Femenino , Granulomatosis con Poliangitis/complicaciones , Humanos , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/complicaciones , Persona de Mediana Edad , Oftalmoscopía , Panoftalmitis/diagnóstico , Panoftalmitis/fisiopatología , Escleritis/diagnóstico , Escleritis/fisiopatología , Índice de Severidad de la Enfermedad , Microscopía con Lámpara de Hendidura , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: We report a rare presentation of extrapulmonary tuberculosis. CASE PRESENTATION: A 29-year-old Burmese woman with human immunodeficiency virus infection and known pulmonary tuberculosis who had been treated for 5 months presented to our hospital with unilateral progressive painful visual loss of 1 month's duration. She was diagnosed with tuberculous panophthalmitis with subretinal and intraorbital abscesses, conjunctival abscess, and extraocular muscle tuberculoma. The diagnosis was confirmed by a conjunctival pus swab with a positive result for acid-fast bacilli and a positive result for a mycobacterial culture. There was high suspicion of multidrug-resistant tuberculosis. Despite receiving ongoing aggressive treatment with conventional antituberculous medications, this patient required subtotal orbital exenteration to control her infection and prevent further progression. Second-line antituberculous medications were added to the first-line therapy, with satisfactory results achieved. CONCLUSIONS: Tuberculous panophthalmitis with intraocular and intraorbital abscesses is a rare presentation of extrapulmonary tuberculosis. Patients who do not respond to first-line antituberculous therapy might be infected with either single-drug or multidrug-resistant Mycobacterium tuberculosis. Patient compliance is one of the key factors that can alter the course of treatment. Careful patient monitoring can improve disease progression, outcome, and prognosis.