Extrapulmonary Tuberculosis Presenting With Isolated Uveitis.

Mycobacterium tuberculosis usually manifests as a pulmonary disease and extra pulmonary tuberculosis is less common (1). Among the patients with extra pulmonary disease, ocular manifestations are rarely reported and the affected individuals usually have concomitant pulmonary findings (1,2). Although ocular tuberculosis is potentially a curable disease, due to absence of enough data, uniform diagnostic and therapeutic protocols are not yet established (3). On the other hand, the wide range of possible diagnosis for inflammatory eye diseases may lead to a diagnostic delay (2-4). Regarding these facts, we describe a challenging patient who was referred to our ophthalmology clinic with pain and redness in both eyes from two weeks earlier. The patient reported poor appetite and significant weight loss without any other accompanying symptoms from eight months earlier for which he was evaluated in several occasions .He had undergone brain, thoracic and abdominal computed tomography (CT) scan without any abnormal findings. Upper and lower gastrointestinal endoscopy in two different occasions were both normal. Previous laboratory studies revealed a chronic normochromic normocytic anemia (He-moglobin: 10.7 gr/dl, Mean-Corpuscular-Volume: 90.8 fl) and increased erythrocyte sedimentation rate (ESR: 115 millimeter/hour). Lymphocyte and platelet counts were both normal. Evaluations for hematological malignancies had been shown no abnormalities. Purified protein derivative (PPD) test was reported to be 13 millimeters, which was considered positive. In ophthalmic exam, vision was 20/50 OD and 20/200 OS. Both eyes had signs of anterior uveitis with presence of cells and flare and mutton fat keratic precipitates but left eye was more severely affected. Furthermore, vitritis and exudative cho-roidal detachment were evident exclusively in the left eye in both fundoscopic exam and so-nographic evaluation. MRI of orbits reported thickening of lateral wall of the left globe, which was isosignal with sclera. Intra and extra conal spaces were reported to be intact. The patient had been received topical corticoster-oids for two weeks without any improvement in clinical symptoms. Regarding his positive PPD test in the absence of pulmonary and extra-pulmonary locus of infection, tuberculosis with primary choroidal involvement was considered as the probable cause of his symptoms. Accordingly, an-ti-tuberculosis therapy with concurrent use of an-ti-inflammatory medications was initiated for the patient. Subsequently the signs and symptoms of uveitis including exudative choroidal detachment of the left eye were diminished in the first month of the treatment and resolved completely throughout three months after initiation of anti-tuberculosis therapy. His systemic non-specific symptoms also disappeared afterwards. One …