Tubercular Uveitis Research Articles

Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment

AimsFew studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate...

P22 Between the devil and the deep blue sea – a diagnostic dilemma

P22 Between the devil and the deep blue sea – a diagnostic dilemma

Tubercular retinal vasculitis in a patient with benign familial fleck retina mimicking frosted branch angiitis

Patients with tubercular uveitis can present in a myriad of clinical findings. Tubercular retinal vasculitis (TRV) mimicking frosted branch angiitis (FBA) is sparsely reported in literature. However, TRV in the background of benign familial fleck retina simulating FBA is never reported. We report a patient of TRV from a tubercular endemic region, supported by ancillary investigations like fundus fluorescein angiography and fundus autofluorescence. The patient was diagnosed as a case of “possible intraocular tuberculosis.” She was managed with systemic and topical steroids along with antitubercular therapy and had a favorable outcome.

Classification Criteria for Tubercular Uveitis

To determine classification criteria for tubercular uveitis. Machine learning of cases with tubercular uveitis and 14 other uveitides. Cases of noninfectious posterior uveitis or panuveitis, and of infectious posterior uveitis or panuveitis, were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were analyzed by anatomic class, and each class was split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the intermediate uveitides. The resulting criteria were evaluated on the validation sets. Two hundred seventy-seven cases of tubercular uveitis were evaluated by machine learning against other uveitides. Key criteria for tubercular uveitis were a compatible uveitic syndrome, including (1) anterior uveitis with iris nodules, (2) serpiginous-like tubercular choroiditis, (3) choroidal nodule (tuberculoma), (4) occlusive retinal vasculitis, and (5) in hosts with evidence of active systemic tuberculosis, multifocal choroiditis; and evidence of tuberculosis, including histologically or microbiologically confirmed infection, positive interferon-γ release assay test, or positive tuberculin skin test. The overall accuracy of the diagnosis of tubercular uveitis vs other uveitides in the validation set was 98.2% (95% confidence interval 96.5, 99.1). The misclassification rates for tubercular uveitis were training set, 3.4%; and validation set, 3.6%. The criteria for tubercular uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Anti-Tubercular Therapy in the Treatment of Tubercular Uveitis a Systematic Review and Meta-Analysis

Background: Tubercular uveitis (TBU) is commonly treated with anti-tubercular therapy (ATT) and corticosteroid or immunosuppressive adjuncts. The objective of this meta-analysis is to quantitatively evaluate the efficacy of ATT in TBU patients. Methods: In this systematic review and meta-analysis, a search of PubMed, EMBASE and Cochrane Library was conducted for articles on ATT outcomes in TBU published between 1 st January 2000 and 1 st August 2021. Study details, demographics, clinical features, investigations that led to a diagnosis of TBU, treatment regimen (ATT, corticosteroids and immunosuppressants), and information on target treatment outcomes was extracted independently by three reviewers. A meta-analysis of proportions was performed. Main outcome measures include inflammation recurrence; inflammation reduction; complete resolution of inflammation; improved visual acuity (VA); ability to taper corticosteroids to < 10 mg/day without inflammatory progression; use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845) Findings: Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI: 0.19-0.60) for TBU patients treated with ATT versus no ATT. For TBU patients treated with ATT, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation and of visual acuity improvement were 13% (n=310/2,216; 95%CI: 9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI: 51-78) respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI: 78-99) of patients, 9% (n=121/1,376; 95%CI: 6-13) of whom were administered concomitant immunosuppressive agents alongside ATT. Interpretation: Treatment of TBU with ATT is associated with a high level of control or improvement of inflammation, followed by a two-thirds improvement in the risk of inflammatory recurrence in TBU patients; only one-seventh of TBU patients have recurrences during follow up. Visual acuity improved in most patients. However, more prospective studies with detailed reporting of ATT regimens, patient subgroups and outcomes are required to elucidate the effectiveness of ATT about other outcome measures. Funding: None to declare. Declaration of Interest: B.K.B, I.P., I.T., R.L.D.N., C.P. and V.G. report no conflicts of interest, financial or propriety, in the subject matter or materials discussed in this manuscript. J.H.K. is a consultant for Gilead Pharma, a company evaluating a treatment for non-infectious uveitis, and equity owner for Betaliq, a company developing an intraocular pressure-lowering treatment. R.A. is supported by a grant from the National Medical Research Council (NMRC), Singapore, for the Clinician Scientist Award (CSA) from 2020-2023. He has not received funding for his work in this publication.

Proteomic profile of vitreous in patients with tubercular uveitis

ObjectiveTo elucidate disease-specific host protein profile in vitreous fluid of patients with intraocular inflammation due to tubercular uveitis (TBU). MethodsVitreous samples from 13 patients with TBU (group A), 7 with non-TBU (group B) and 9 with no uveitis (group C) were analysed by shotgun proteomics using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). Differentially expressed proteins (DEPs) were subjected to pathway analysis using WEB-based Gene SeT Analysis Toolkit software. ResultsCompared to control groups (B + C combined), group A (TBU) displayed 32 (11 upregulated, 21 downregulated) DEPs, which revealed an upregulation of coagulation cascades, complement and classic pathways, and downregulation of metabolism of carbohydrates, gluconeogenesis, glucose metabolism and glycolysis/gluconeogenesis pathways. When compared to group B (non-TBU) alone, TBU displayed 58 DEPs (21 upregulated, 37 downregulated), with an upregulation of apoptosis, KRAS signaling, diabetes pathways, classic pathways, and downregulation of MTORC1 signaling, glycolysis/gluconeogenesis, and glucose metabolism. ConclusionThis differential protein profile provides novel insights into the molecular mechanisms of TBU and a baseline to explore vitreous biomarkers to differentiate TBU from non-TBU, warranting future studies to identify and validate them as a diagnostic tool in TBU. The enriched pathways generate interesting hypotheses and drive further research.

Newer trends in tubercular uveitis: a case series with systemic correlation.

To determine the spectrum of uveitis, causes of visual loss in systemic tuberculosis (TB), role of investigations and outcome after anti-TB therapy (ATT). A retrospective study was conducted on 250 patients with systemic TB at a referral center in Chennai, South India from April 2016 to May 2019. Systemic workup comprised of Mantoux, chest X-ray, polymerase chain reaction (PCR) and QuantiFERON (QFT) TB Gold. Aqueous humor analysis by nested PCR or real time PCR (RT-PCR) and ancillary ophthalmic investigations such as fundus fluorescein angiography, optical coherence tomography were performed. Multifocal choroiditis and vasculitis were the most common manifestations (39% and 24% respectively) together accounting for 61% of cases and they had a higher risk of recurrence (3%). Pulmonary tuberculosis (PTB) was more frequently associated with uveitis (18%). Among those with extra-pulmonary tuberculosis (EPTB), uveitis occured in miliary TB (2%), bone (1%) and abdominal TB (1%). Complications such as cystoid macular edema, choroidal neovascular membranes and macular scarring caused visual loss. Aqueous humor analysis detected mycobacterium TB antigen. Collectively, systemic investigations such as chest X-ray, Mantoux test and those performed on blood samples such as PCR and QFT were positive in 39% of patients. In inconclusive patients, nested PCR and/or RT-PCR were done on aqueous humor samples and were diagnostic in 96%. A combination of tests was diagnostic in 92%. ATT in isolation in 71% and combined with corticosteroids in 29% was used for treatment of which signs of resolution and improvement in vision started as early as 6wk in those who were started immediately on corticosteroids and ATT and longer than 3mo in those on ATT alone. Prompt treatment with ATT and corticosteroids improved vision in 23% of our patients within 2mo. Vitritis with choroiditis causes cystoid macular oedema and requires longer duration of ATT. Vision improved in 69%. Complete resolution occurred in 75% and worsening in 12%. A combination of investigations guided by clinical suspicion helps in precise diagnosis. In diagnostic dilemmas analysis of ocular samples is reliable and confirmatory. Screening all patients and a multidisciplinary approach in TB (active, healed or during treatment) is recommended.

Uveitis associated with latent tuberculosis: A comparative study of the impact of antitubercular therapy combined or not with systemic corticosteroids.

To study the outcome of latent tubercular uveitis (LTBU) treated with antitubercular therapy (ATT) combined or not with adjuvant systemic corticosteroids. Twenty patients (27 eyes) with LTBU were included in a monocentric retrospective study and evaluated for the absence of active disease after treatment. Data on the clinical outcomes (active inflammation), vision (best-corrected visual acuity, BCVA) and treatment were collected retrospectively. Fourteen patients received ATT alone and six patients received ATT combined with systemic corticosteroids. The two groups were not comparable in terms of proportion of tubercular panuveitis cases and initial BCVA (59.3 ± 8.2 letters vs 44.2 ± 15.2 letters). There was no significant difference in remission rate and in BCVA between both groups 3 months after ATT discontinuation. Patients with LTBU treated with ATT alone had visual and inflammatory outcomes at least comparable to those of patients treated with ATT combined with systemic corticosteroids.

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 447 Patients with Tubercular Intermediate Uveitis and Panuveitis

ABSTRACT Purpose: Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP. Methods: Multicentre retrospective analysis. Results A total of 138 TIU and 309 TBP patients were included. A total of 382 subjects received antitubercular therapy (ATT) (n = 382/447; 85.4%) and 382 received corticosteroids (n = 382/447; 85.4%). Treatment failure was observed in 78 individuals (n = 78/447; 17.4%), occurring less frequently in patients receiving ATT (n = 66/382; 17.2%) compared to those who did not (n = 12/65; 18.5%). The study did not show any statistically significant therapeutic effect of ATT in patients with TIU and TBP. Conclusion Taking into account the limitations of the retrospective, non-randomized study design, resultant reliance on reported data records, and unequal size of the samples, the current study cannot provide conclusive evidence on the therapeutic benefit of ATT in TIU and TBP.

IS1081-based Multi-targeted LAMP: An Opportunity to Detect Tubercular Uveitis

ABSTRACT Background – Timely and accurate diagnosis of tubercular uveitis (TBU) is imperative, hence multitargeted loop-mediated isothermal amplification (MLAMP) using three gene targets (IS1081, IS6110 and MPB64) was evaluated for it. Methods – About 120 vitreous fluid samples [70 clinically suspected TBU (3 culture-positive, 67 culture-negative) and 50 controls] were subjected to MLAMP to evaluate its performance in diagnosing TBU. Results – Overall, the sensitivity, specificity, PPV and NPV of MLAMP in the diagnosis of TBU was 77.14%, 100%, 100% and 75.75%, respectively, with an additional detection of 9 (12.85%) cases (5 by IS1081LAMP and 2 each by MPB64LAMP and IS6110LAMP). Maximum TBU cases were detected by IS1081LAMP (50/70) followed by MPB64LAMP (47/70) and IS6110LAMP (45/70). Conclusion – MLAMP, with the incorporation of IS1081, served as a sensitive, rapid, simple and cost-effective technique for TBU diagnosis.

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Descriptive Review of Tubercular Uveitis in Paediatric Population

ABSTRACT Purpose: To examine disease profile of tubercular uveitis (TBU) in Paediatric population. Methods: Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed. Results: Mean age of disease presentation was 12.8 (range 4–18 years), with predominance of males (n = 14/20; 70.0%) and Asian ethnicity (n = 25/29; 86.2%). Posterior uveitis (n = 14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n = 11/17). Incidence of optic disc edema and macular edema was higher in children (n = 8/18; 44.4% and n = 5/18; 27.8%, respectively) than in adults (n = 160/942; 16.9% and n = 135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n = 1/21). Conclusions: Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome.

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 165 Patients with Tubercular Anterior Uveitis

ABSTRACT Purpose The Collaborative Ocular Tuberculosis Study (COTS) Group sought to address the diagnostic uncertainty through retrospective cohort analysis of treatment regimens and therapeutic outcomes for patients with tubercular Anterior Uveitis (TAU) across international centers. Methods Multicentre retrospective analysis of patients diagnosed with TAU between January 2004 to December 2014 that had a minimum follow-up of 1 year. Results One hundred and sixty-five patients were included. One hundred and seven subjects received antitubercular therapy (ATT) (n = 107/165; 64.9%) with all the patients receiving topical steroid therapy. Treatment failure was noted in 17 patients (n = 17/165; 10.3%), more frequently described in patients that received ATT (n = 13/107, 12.2%), than those that did not receive ATT (n = 4/58, 6.9%). Conclusion In this retrospective study, addition of ATT did not have any statistically significant impact on outcome in patients with TAU.

Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis

The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, set up an international, expert-led consensus project to develop evidence- and experience-based guidelines for the management of tubercular uveitis (TBU). The absence of international agreement on the use of antitubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition. Consensus statements for the initiation of ATT in TBU were generated using a 2-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular retinal vasculitis (TRV) administered by the experts, after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance with the second round of the modified Delphi process. Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU, and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive. The COTS consensus guidelines were generated based on the evidence from published literature, specialists' opinions, and logic construction to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions that should be treated as tuberculosis.

YELLOW SUBRETINAL PIGMENT EPITHELIUM DEPOSITS: A NOVEL SIGN IN OCULAR TUBERCULOSIS.

To describe a novel clinical and imaging finding in patients with tubercular posterior uveitis. A retrospective review of 3 cases presented at a tertiary referral eye centre in North India was performed between June 2016 and March 2019. All the patients had received an initial diagnosis of noninfective etiologies (sympathetic ophthalmia, necrotizing scleritis, and lymphoma). Fundus photography, fluorescein angiography, fundus autofluorescence, and enhanced-depth imaging optical coherence tomography were reviewed. Three patients (all Asian Indian women: aged 18, 49, and 52 years) diagnosed with panuveitis were investigated for various etiologies based on the initial clinical suspicion. During the course of therapy, all the patients developed peripheral yellow subretinal pigment epithelium deposits (YSRPE) which appeared hypoautofluorescent on fundus autofluorescence and initially hypofluorescent with late hyperfluorescence on fluorescein angiography. The patients were subjected to detailed systemic evaluation and laboratory tests. All the patients showed acid-fast bacilli on invasive tissue biopsies. After initiation of antitubercular therapy, the lesions resolved in all eyes. Yellow subretinal pigment epithelium deposits represent a novel and important diagnostic sign of tubercular posterior uveitis.

Clinical and Epidemiological Study on Tubercular Uveitis in a Tertiary Eye Care Centre in Italy.

Purpose To describe frequency, clinical characteristics, and visual prognosis of tubercular uveitis (TBU) in a nonendemic country. Methods We retrospectively reviewed 3743 charts of patients with endogenous uveitis visited from 2008 to 2018 at a tertiary referral centre in Rome, Italy. We included immunocompetent patients with diagnosis of TBU. Patients were divided in two groups: patients with history of uveitis without a previous diagnosis of TBU (group A) and patients at their first episode of TB uveitis (group B). Results TBU was diagnosed in 28 (0.75%) out of 3743 patients. Twelve (42.9%) patients came from tuberculosis endemic areas. All patients received specific antitubercular treatment (ATT) and were evaluated for a mean follow-up of 3.2 ± 2.9 years. Group A showed a greater number of ocular complications when compared with group B. ATT was effective in reducing the frequency of recurrences of uveitis in patients of group B. Conclusion Intraocular inflammation can be the first manifestation of tuberculosis. Our data highlight that early diagnosis and specific treatment of TBU may allow to decrease recurrences and to improve visual outcomes.

Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 1: Guidelines for Initiating Antitubercular Therapy in Tubercular Choroiditis

An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis. The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like choroiditis, tuberculoma, and tubercular focal or multifocal choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular choroiditis. Experts agreed on initiating ATT in tubercular choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.

Outcome of cataract surgery in eyes with uveitis.

To assess the outcome of cataract surgery in patients with uveitis without the use of prophylactic high dose (> 5-10 mg/day) systemic steroid. A hospital based prospective study enrolling 64 eyes of 60 patients with uveitis and cataract from May 2013 to April 2014 having intraocular inflammation under control for at least 3 months preoperatively and underwent phacoemulsification with in bag placement of foldable acrylic intraocular lens (IOL). Twenty six male and 34 female were included with mean age of 47.23 ± 16.85SD (16-85) years. In 43.75 % of eyes the uveitis was idiopathic followed by sarcoiduveitis (18.7%), Herpetic uveitis (15.6%), Tubercular uveitis (6.2%), VKH (4.6%), HLAB 27(4.6%), Behcet's, endogenous endophthalmitis, Wegener's granulomatosis and lepromatous uveitis (1.5% each). Anterior chamber cell count was grade 1+ in 33 eyes (51.56%) on 1st post-operative day and in 29 eyes (45.31%) on second follow up. Out of total 11 eyes (17.18%) that developed fibrin, 7 eyes were treated with subconjunctival injection of dexamethasone with half hourly topical steroid drops. Other 4 eyes that developed fibrin responded to half hourly topical steroid. Dose of oralprednisolone increased in 6 patients in early post operative duration. At the final follow up, 50 eyes (92.58% ) had improvement in best corrected visual acuity and cystoidmacular edema (CME) in 5% (n=3) eyes. Even without the use of preoperative high dose of oral steroid, inflammation was under control with significant improvement in visual acuity 3 months postoperatively.

Standardization of Nomenclature for Ocular Tuberculosis – Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop

ABSTRACT Purpose: To standardize a nomenclature system for defining clinical phenotypes, and outcome measures for reporting clinical and research data in patients with ocular tuberculosis (OTB). Methods: Uveitis experts initially administered and further deliberated the survey in an open meeting to determine and propose the preferred nomenclature for terms related to the OTB, terms describing the clinical phenotypes and treatment and reporting outcomes. Results: The group of experts reached a consensus on terming uveitis attributable to tuberculosis (TB) as tubercular uveitis. The working group introduced a SUN-compatible nomenclature that also defines disease “remission” and “cure”, both of which are relevant for reporting treatment outcomes. Conclusion: A consensus nomenclature system has been adopted by a large group of international uveitis experts for OTB. The working group recommends the use of standardized nomenclature to prevent ambiguity in communication and to achieve the goal of spreading awareness of this blinding uveitis entity.

The Emerging Challenge of Diagnosing Drug-resistant Tubercular Uveitis: Experience of 110 Eyes from North India

ABSTRACT Background: Rapid and timely diagnosis of tubercular uveitis (TBU) is of paramount importance to save these eyes from blindness. The present study was, therefore, undertaken to carry out a comparative evaluation of Gene Xpert MTB/RIF (Xpert), MTBDRplus and Multiplex PCR (MPCR) for the diagnosis of TBU. These tests were performed on vitreous fluid of 110 patients with presumed TBU and 90 controls. rpoB gene sequencing confirmed Rifampicin resistance. Results: Xpert, MTBDRplus and MPCR were positive in 19(17.2%),38 (34.5%) and 79 (71.8 %) patients, respectively. All tests were negative in all controls. Rif resistance was detected in 3 by Xpert and 7 by MTBDRplus. MPCR followed by rpoB gene sequencing detected Rif resistance in 6 cases. One case of false Rif resistance was reported each by MTBDRplus and Xpert. Conclusion: MPCR followed by rpoB sequencing is a robust technique for the diagnosis of paucibacilliary condition like TBU and reliable detection of drug resistance.

Miliary Tuberculosis with Tubercular Uveitis Presenting as Fever of Unknown Origin: A Case Report

Miliary tuberculosis is a form of disseminated tuberculosis, which is more frequent in immunocompromised patient. Ocular involvement of mycobacterium tuberculosis is also an uncommon presentation of disseminated tuberculosis. Tubercular uveitis is most frequent form of ocular tuberculosis. If treatment is delayed, it may cause loss of vision. In many case of the systemic TB with ocular involvement, there may be no eye symptoms in early stage. On the other hand, many cases of ocular TB may not have any evidence of systemic TB. Here we have described a case of miliary tuberculosis with ocular uveitis who initially presented with fever without any significant physical findings and later developed eye symptoms including diminished vision.&#x0D; Bangladesh J Child Health 2019; VOL 43 (2) :126-130