Tuberculous Posterior Sclero-Uveitis with Features of Vogt-Koyanagi-Harada Uveitis: An Unusual Case

Abstract

Patient: Male, 32Final Diagnosis: Ocular tuberculosis (tuberculous posterior sclero-uveitis with features of Vogt-Koyanagi-Harada uveitis)Symptoms: Pain and progressive visual impairment of his left eyeMedication: Systemic anti-tuberculosis treatment (6-month course)Clinical Procedure: Thorough ophthalmological and systemic explorationSpecialty: OphthalmologyObjective:Rare diseaseBackground:Ocular tuberculosis (TB) is a clinical entity that presents with a wide range of clinical manifestations. It is regarded as an extremely challenging condition from the point of view of diagnostic approach and calls for early diagnosis and prompt treatment, as it can potentially lead to blindness.Case Report:This is a case report of a 32-year-old male from southern India who has been living and working in Greece over the last 10 years and presented with 2-week history of pain and progressive visual impairment of his left eye. He underwent a thorough clinical ophthalmological examination and imaging of the fundus, and the findings were consistent with uveitis. However, the manifestations of the inflammation were complicated as they included features that could be attributed mainly to Vogt-Koyanagi-Harada (VKH) disease and tuberculous serpiginous-like uveitis. Therefore, a systemic evaluation, together with specific laboratory and paraclinical investigations, were carried out to define the etiology of the inflammation and develop an optimal therapeutic plan. Taking into account specific findings from the chest imaging, a positive purified protein derivative (PPD) skin test, and sputum cultures positive for Mycobacterium tuberculosis (MTB), we set a diagnosis of posterior sclero-uveitis and started our patient on anti-tuberculous treatment.Conclusions:This case reveals an atypical manifestation of tuberculous sclero-uveitis imitating Vogt-Koyanagi-Harada disease together with a few characteristics of serpiginous-like tuberculous uveitis, emphasizing the fact that tuberculosis should always be included in the differential diagnosis of uveitis when there is no obvious underlying disease.

The Large Hellenic Study of Uveitis: Diagnostic and Therapeutic Algorithms, Complications, and Final Outcome

“…Our study underlines that the development of novel diagnostic tools5 increased the diagnostic accuracy. Moreover, the characterization of novel clinical forms in different types of uveitis6 has affected their incidence and led to the description of new subsets of each disease. Similarly, in syphilis7 or other types of infectious uveitis,8 PCR enhanced the ability of setting an early and accurate diagnosis 9…”

Tuberculose e Tomografia de Coerência Óptica: Uma revisão sistemática das manifestações oculares / Tuberculosis and Optical Coherence Tomography: A systematic review of eye manifestations

“…Outro caso clínico dramático relatado pela literatura foi a necessidade de distinção entre a síndrome de Vogt-Koyanagi-Harada (VKH, uveomeningoencefalite autoimune, que afeta melanócitos) e TBO em um homem de 32 anos (KALOGEROPOULOS et al, 2017). Este paciente evoluiu com deficiência visual progressiva do olho esquerdo cujo achado na TCO correspondeu a edema do disco óptico, dobras retinianas e descolamento retiniano exsudativo macular com líquido turvo, que são aspectos marcantes da VKH (O'KEEFE;RAO, 2017).…”

Tubercular Harada disease – An unreported uveitic entity

“…It's a known fact that the use of immunosuppressant raises the risk of opportunistic infections which can be bacterial or viral since it causes immunological derangement in Natural Killer cells, CD-4, and CD-8 cells [ 16 , 17 ]. We found another report on a rare case of bilateral asymmetrical tuberculous sclero-uveitis presenting as a Vogt-Koyanagi-Harada (VKHD)-like/serpiginous-like TB uveitis [ 18 ]. Moreover, a recent case highlighted the diagnostic dilemma between VKHD and TB, and the possibility of reactivation of latent TB on immunosuppression.…”