Título

INTRAOCULAR TUBERCULOSIS WITHOUT PULMONARY INVOLVEMENT – A CHALLENGE IN THE ABSENCE OF PPD TEST

Introdução / Purpose

To report a case of ocular tuberculosis without pulmonary disease, which had a delayed diagnosis because of the lack of PPD tests in North of Brazil.

Material e Método / Methods

Case report.

Resultados / Results

The re-establishment of the supply of PPD tests made possible a less invasive ocular tuberculosis diagnosis. As soon as the patient started to treat the disease, his visual acuity improved. He responded very well to laser therapy.

Discussão e Conclusões / Discussion

P.R.S.R., male, 19 years-old, complaint of progressive worsening of his left vision during the last four months. He denied other medical conditions. Right eye had no abnormalities. BCVA OS CF 3m. Biomicroscopy within normal. IOP 12mmHg. OS fundoscopy with macular ILM folds, flame-shaped retinal hemorrhages in the inferior temporal arcade, as well as cotton-wool spots, vascular sheating throughout all 4 quadrants. He was submitted to laboratorial tests and cardiac evaluation. All his exams came negative, but he was not able to do PPD test because there were no PPD kits in the region. He was submitted to peripheral photocoagulation due to ischemia. His BCVA improved to 20/25. A month later, he was able to do the PPD, which came positive. He was referred to infectologist, who diagnosed latent tuberculosis. He was started in four-drug regiment and is stable. The lack of PPD tests had a severe impact in the diagnosis of intraocular cases without pulmonary disease. To treat these patients is also a challenge, once the sanitary authorities need a confirmation of the disease to start the long treatment. New tests had been developed, like Igra, but they still are not available.

Palavras Chave

Tuberculosis, photocoagulation, PPD.