Tuberculous scleritis

Abstract

Tuberculosis is a multifaceted disease, it is called the great imitator because it can take many appearances, especially in the eye. Ocular manifestations in tuberculosis are rare, since they are observed in only 1 to 2% of cases. It can accompany the general manifestations of the disease or be isolated. We report a case of a 64-year-old patient, who consulted the emergency room for the impaired general condition with fever. The onset of symptoms dates back to two months, marked by the appearance of a pulmonary infection on day 7 after surgery for the anal abscess put on antibiotic therapy without improvement. Clinical examination found asthenia, anorexia, weight loss of 12 kg in 2 months with fever at 41 °C and headache. The pleuro-pulmonary examination and for tuberculin were positive. An ophthalmological opinion was requested following a painful red eye reported by the patient. The ophthalmological examination found on inspection a red scleral nodule of the prelimbic right eye richly vascularized in the lower temporal quadrant, more or less painful (A, C, E). Visual acuity is 10/10 in both eyes and slit-lamp examination shows slight conjunctival hyperemia, a richly vascularized scleral nodule per limbic inferior temporal, fixed on the deep planes. The rest of the ophthalmologic examination is unremarkable. When pulmonary tuberculosis was confirmed, anti-tuberculosis treatment was instituted. Evolusion on d-15 is marked by a good evolution on the general plan and on the plan ophthalmologic with regression of inflammatory signs with almost disappearance of the scleral noduleand persistence of a small conjunctival uplift next to the lesion (B, D, F).