Tuberculous uveitis presenting as pigmented hypopyon – A case report

Purpose Hypopyon in the eye is an alarming sign. A case of tuberculous uveitis which presented with pigmented hypopyon has been described. The aim of this paper is to report pigmented hypopyon, a rare presentation of tuberculous uveitis in a diabetic patient. Observations A 42-year-old patient with diabetes with a known history of miliary tuberculosis, on anti-tubercular therapy since two months presented with complaints of pain and redness followed by diminution of vision in the right eye since one month. Visual acuity was counting fingers close to face in right eye. Anterior chamber (AC) showed grade 4 cells and flare with a pigmented hypopyon measuring two mm. Fundus details were not made out. B scan revealed increased choroidal thickness with moderate vitritis. Routine blood counts revealed leucopenia and anemia suggestive of an immunosuppressed state. AC tap analysis was not helpful in diagnosis initially. Patient was lost to follow up and presented one month later with three - fourth of AC having hypopyon. AC wash was done and the AC sample evaluation revealed acid fast bacilli. Polymerase chain reaction results confirmed it to be Mycobacterium tuberculosis. Conclusions and importance Tuberculous anterior uveitis thus presenting as pigmented hypopyon is very rare and can cause diagnostic difficulties. High index of suspicion in tuberculosis endemic areas is a must for a prompt diagnosis. A possible association between immunosuppression and pigmented hypopyon may exist and needs to be studied further.