Melkersson-Rosenthal syndrome in a patient with tubercular panuveitis.

We report a rare presentation of Melkersson-Rosenthal syndrome in a patient with tubercular panuveitis. A 45-year-old male being treated with antitubercular therapy for tubercular panuveitis presented with unilateral, non-pitting right upper eyelid edema. Excision biopsy showed granulomatous inflammation involving the lymphatics. Immunohistochemistry confirmed the presence of histiocytes around the lymphatics.

Utility of QuantiFERON TB gold test in a south Indian patient population of ocular inflammation.

AIM: To study the utility of interferon-g release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation. DESIGN: Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008. MATERIALS AND METHODS: QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39). RESULTS: The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively. CONCLUSIONS: QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.

Role of the mantoux test and treatment with antitubercular therapy in a South Indian patient population of presumed intraocular tuberculosis.

AIM: To assess the role of mantoux test and ATT in presumed intraocular tuberculosis in South India. MATERIALS & METHODS: Retrospective study of 51 records of patients with recurrent uveitis with a documented positive mantoux test and a minimum of 1 year followup from the time of initiation of ATT between January 1997 and May 2008. The main outcome measure was the recurrence of inflammation after 1 year of starting ATT. RESULTS: There was a significant reduction in the number of recurrences of uveitis post ATT (.000). CONCLUSIONS: There is a definite role of ATT in latent TB with uveitis.

Bilateral retinitis following chikun- gunya fever.

A 35-year-old male with a history of chikungunya fever, presented with diminution of vision in the right eye of one-week duration. His best corrected visual acuity (BCVA) was counting fingers 2 meters and 20/20 (Snellens) in the right and left eyes respectively. A diagnosis of neuroretinitis was made in the right eye while left eye showed features of retinitis. ELISA (serum) and polymerase chain reaction (aqueous) were positive for herpes simplex virus. The lesions did not show any response to antiviral or steroid treatment and appeared to be self-limiting. At five months follow-up, lesions had resolved well with BCVA of 20/120 and 20/20 in the right and left eyes respectively.