Subject(s)
Blindness/etiology , Granulomatosis with Polyangiitis/diagnosis , Lung Diseases/diagnosis , Panophthalmitis/complications , Scleritis/complications , Visual Acuity , Visual Perception/physiology , Blindness/diagnosis , Blindness/physiopathology , Female , Granulomatosis with Polyangiitis/complications , Humans , Lung/diagnostic imaging , Lung Diseases/complications , Middle Aged , Ophthalmoscopy , Panophthalmitis/diagnosis , Panophthalmitis/physiopathology , Scleritis/diagnosis , Scleritis/physiopathology , Severity of Illness Index , Slit Lamp Microscopy , Tomography, X-Ray ComputedABSTRACT
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.