Bilateral Interstitial Keratitis and Granulomatous Uveitis of Tubercular Origin

Abstract

Tuberculosis (TB) is an important cause of ocular morbidity. Establishing a diagnosis may be difficult in some situations especially with unusual presentation. We report case of bilateral interstitial keratitis (IK) associated with anterior uveitis as a presenting feature of ocular TB from India. A 17-year-old woman presented with diminution of vision in both eyes. Slit lamp biomicroscopy showed central bilateral IK and active granulomatous uveitis. Laboratory investigations revealed raised erythrocyte sedimentation rate (50 mm/hr) and positive tuberculin test (22 mm induration) and QuantiFERON-TB Gold test (3.34 IU/mL), with no foci of systemic infection. Presumptive diagnosis of ocular TB was made. The patient was started on antitubercular therapy and topical steroids, after which symptoms and signs resolved. There was no recurrence of the disease for 1 year after completion of antitubercular therapy. Bilateral central IK with granulomatous uveitis is probably related to the presence of tubercular antigen in aqueous humor. Positive QuantiFERON-TB Gold test is useful for initiating the antitubercular treatment where unusual presentation is encountered.