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Bilateral Interstitial Keratitis and Granulomatous Uveitis of Tubercular Origin

Kamal, Saurabh M.S., D.N.B.; Kumar, Rakshit M.D.; Kumar, Sushil M.D.; Goel, Ruchi M.S., D.N.B.

Eye & Contact Lens: Science & Clinical Practice:
doi: 10.1097/ICL.0b013e31827a025e
Case Report
Abstract

Background: Tuberculosis (TB) is an important cause of ocular morbidity. Establishing a diagnosis may be difficult in some situations especially with unusual presentation. We report case of bilateral interstitial keratitis (IK) associated with anterior uveitis as a presenting feature of ocular TB from India.

Methods: A 17-year-old woman presented with diminution of vision in both eyes. Slit lamp biomicroscopy showed central bilateral IK and active granulomatous uveitis. Laboratory investigations revealed raised erythrocyte sedimentation rate (50 mm/hr) and positive tuberculin test (22 mm induration) and QuantiFERON—TB Gold test (3.34 IU/mL), with no foci of systemic infection.

Results: Presumptive diagnosis of ocular TB was made. The patient was started on antitubercular therapy and topical steroids, after which symptoms and signs resolved. There was no recurrence of the disease for 1 year after completion of antitubercular therapy.

Conclusions: Bilateral central IK with granulomatous uveitis is probably related to the presence of tubercular antigen in aqueous humor. Positive QuantiFERON—TB Gold test is useful for initiating the antitubercular treatment where unusual presentation is encountered.

Author Information

Guru Nanak Eye Centre (S.K., S.K., R.G.), Maulana Azad Medical College, New Delhi, IndiaDepartment of Medicine (R.K.), Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India.

Address correspondence to Saurabh Kamal, M.S., D.N.B., Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India 110002; e-mail: drskamal@gmail.com

The authors have no funding or conflicts of interest to disclose.

Accepted October 18, 2012

© 2014 Contact Lens Association of Ophthalmologists, Inc.