RESUMO
PURPOSE: To present a case of necrotizing sclerokeratitis in a patient with multidrug-resistant tuberculosis and study the challenges in diagnosis and management of anterior tuberculous scleritis. METHODS: Retrospective observational case report and review of anterior tuberculous scleritis. RESULTS: A 28-year-old woman, previously diagnosed as presumed tubercular panuveitis, presented with necrotizing sclerokeratitis and progressed to develop panophthalmitis. Laboratory investigations revealed multidrug-resistant Mycobacterium tuberculosis as the etiological agent. We reviewed cases of anterior tuberculous scleritis published in the literature, with regards to clinical features, microbiological investigations, treatment, and outcomes. Treatment includes standard antitubercular therapy, with or without systemic corticosteroids. Poor response to treatment is seen either due to delayed diagnosis or drug resistance, and the significance of the same is highlighted in our case. CONCLUSION: Diagnosis of tuberculous scleritis is a challenge. Therapeutic failure must alert the clinician for drug resistance which is diagnosed early, can prevent the devastating outcomes.
Assuntos
Ceratite , Esclerite , Tuberculose Ocular , Tuberculose , Adulto , Antituberculosos/uso terapêutico , Resistência a Múltiplos Medicamentos , Feminino , Humanos , Ceratite/diagnóstico , Estudos Retrospectivos , Esclerite/diagnóstico , Esclerite/tratamento farmacológico , Esclerite/etiologia , Tuberculose/complicações , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológico , Tuberculose Ocular/microbiologiaRESUMO
Purpose: To describe the clinical pattern of scleritis in patients ≤16 years of age at a tertiary care eye hospital in India. Methods: The medical records of 24 eyes of 20 children with scleritis were included in this retrospective study. Collected data included age, subsets of uveitis, best corrected visual acuities (BCVA), detailed laboratory investigations and treatment. Results: Mean age at presentation was 12.2 ± 2.5 years. Scleritis was unilateral in 80% patients and an equal gender distribution was observed. Posterior scleritis (41.7%) was the most common subtypes of scleritis and nodular scleritis was the most common type of anterior scleritis (33.3%). Necrotizing scleritis was seen in 16.7% eyes. Tuberculosis was the only systemic association and found in three (15%) patients. Conclusions: Clinical profile of scleritis in children can be different from that of adults.
Assuntos
Esclera/patologia , Esclerite/diagnóstico , Centros de Atenção Terciária , Adolescente , Distribuição por Idade , Biópsia , Criança , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Masculino , Estudos Retrospectivos , Esclerite/epidemiologia , Distribuição por Sexo , Acuidade VisualRESUMO
CASE REPORT: We present the case of a 26 year-old Pakistani male, who after the presumptive diagnosis of anterior tuberculous scleritis (by an atypical clinical appearance and positive epidemiological link), was diagnosed with pulmonary tuberculosis. DISCUSSION: Nodular anterior scleritis is an uncommon presentation of tuberculosis (TB). It is considered a diagnostic challenge because of the difficulty to extract bacilli from the ocular tissue. However, a detailed medical history and eye examination can be the key to an accurate diagnosis and appropriate treatment of the TB.