Título / Title

NODULAR POSTERIOR SCLERITIS ASSOCIATED WITH PRESUMED OCULAR TUBERCULOSIS: A MULTIMODAL IMAGING CASE REPORT

Introdução / Purpose

To describe a patient with nodular posterior scleritis associated with presumed ocular tuberculosis (TB).

Material e Método / Methods

Case report.

Resultados / Results

A 25-year-old Caucasian man reported metamorphopsia in the right eye (OD). He had lost the vision in his left eye when he was 15 years old. The visual acuity (VA) levels were 20/20 and light perception in the right and left eyes, respectively. Wide-field color fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography, and ultrasound suggested an inflammatory condition associated with an elevated lesion in the choroid/sclera. The purified protein derivative (PPD) skin test and all other screening tests were negative. A diagnosis of presumed nodular posterior scleritis was made and after oral corticosteroid therapy, the VA decreased to 20/100 OD associated with a red and painful eye. Subsequently a QuantiFERON-TB test was positive, tuberculosis (TB) treatment was started and the corticosteroid dose was increased. Three months after treatment, the pain resolved and the vision OD recovered to 20/20.

Discussão e Conclusões / Conclusion

Nodular posterior Scleritis is a non-common manifestation of ocular TB. PPD testing shows tuberculosis cellular immune response of the pacient. 40% of ocular TB showed negative PPD tests. In pacients with clinical suspect without positive PPD, IGRA testing can assist diagnose TB with sensibility increased and lower specificity. When TB is confirmed, antitubercular treatment should be initiated associated with steroids, which prevents damage to the ocular tissues due the inflammatory response. In summary, ocular TB is not always easy to diagnose. The differential diagnosis is large and there is no pathognomonic sign or a gold standard examination. A high index of suspicion, multimodal imaging testing, and results of skin and blood tests help to establish a diagnosis with certainly and initiate early treatment, thus avoiding irreversible visual loss.

Palavras Chave

scleritis, tuberculosis, uveitis, OCT, wide-field fundus photo

Area

CLINICAL RETINA