Macular granuloma due to tuberculosis without pulmonary symptoms

Albert Costa Rebello,João Helio Leonardo De Sousa,José Gilberto De Sá,Karime Kalif De Sousa Rebello

doi:10.5935/0034-7280.20150052

Albert Costa Rebello, João Helio Leonardo De Sousa + Show 2 more

Open Access

https://doi.org/10.5935/0034-7280.20150052

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Abstract

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis.The main site of involvement is the lung, but the bacillus may spread by hematogenous/lymph systems to other organs, including the eye.The incidence of ocular TB is 1-2% of extra-pulmonary cases. The authors present a case of a 28 years old female patient seeking medical care due to reduction of visual acuity in the left eye for 8 days. She had the best corrected visual acuity in the affected eye of 20/200, and the opposite eye was 20/20. At fundoscopy was shown a granuloma in the macular area of the left eye, with retinal edema and hemorrhage. After diagnostic investigation the patient was treated with antibiotic therapy for tuberculosis during 6 months, obtaining lesion regression and visual acuity improvement to 20/50.

Highlights

Brazil is one of 22 countries prioritized by the World Health Organization (WHO) covering 80% of the global cases of tuberculosis(1)
Given the high prevalence of the disease in our country, it is always advisable to investigate tuberculosis in cases of chorioretinitis. It is a especially important fact, considering that some treatments directed to other etiologies may worsen the tuberculosis condition
The standard test for the diagnosis finding Mycobacterium tuberculosis in ocular specimens, but due to the paucibacillary lesions and the noble condition of the visual apparatus significantly limit the histological study, the diagnosis of ocular tuberculosis is supported by epidemiological data, clinical examination, positive tuberculin skin test and laboratory exclusion of other conditions(5), among them toxoplasmosis

Summary

INTRODUCTION

Brazil is one of 22 countries prioritized by the World Health Organization (WHO) covering 80% of the global cases of tuberculosis(1). In Rio de Janeiro the incidence rate is 73.99 per 100,000 inhabitants, giving the state a sad first place when compared to other States(2). According to data collected by the Ministry of Health and the Department of Health Surveillance, in the case of extra pulmonary tuberculosis the incidence rate drops to 10.06 per 100,000 inhabitants in Rio de Janeiro. This number includes the cases of pleural, lymph node, osteoarticular, genitourinary, intestinal, peritoneal, pericardial, central nervous system, eye and skin tuberculosis(3,4). After follow-up for 6 months, with the respective end of the oral treatment, the patient improved the visual acuity of the left eye to 20/50. The lesion improved and the retinal edema disappeared, the hemorrhage was absorbed and the retinal pigment epithelium in the macular area was atrophied (Figure 2)

CASE REPORT

Findings

DISCUSSION