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Presumed Tuberculous Neuroretinitis in a Patient With Negative Quantiferon Gold and Tuberculin Skin Tests

Husney, Robert MD; Husney, Daniel MD; Ghitan, Monica MD; Chapnick, Edward K. MD

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e3182602054
Case Reports
Abstract

Background: Mycobacterial tuberculosis is a multisystem infection that can affect nearly any organ. We report a case of tuberculous neuroretinitis in an otherwise healthy man from Honduras with negative Tuberculin Skin Test and Quantiferon Tuberculosis Gold tests.

Case Report: A 26-year-old man from Honduras presented with acute painless loss of vision in his left eye for 5 days. Ophthalmic examination was remarkable for decreased visual acuity in the left eye. The patient was admitted and treated with intravenous steroids for suspected retinal vasculitis. Computed tomographic scans of the brain and the orbit were unremarkable. A computed tomographic scan of the chest showed a right apical nodule. Acid-fast stains, tuberculin skin test, and Quantiferon testing all returned negative. Biopsy of the lung nodule confirmed the diagnosis of Mycobacterium tuberculosis neuroretinitis.

Conclusion: Our case illustrates the importance of pursuing a diagnosis when clinical suspicion is high, even in the absence of supportive laboratory findings

Author Information

From the Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY and Division of Ophthalmology, Westchester Medical Center, Valhalla, NY.

Correspondence to: Robert Husney, MD, Maimonides Medical Center, Brooklyn, NY. E-mail: rhusney@maimonidesmed.org.

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

© 2013 Lippincott Williams & Wilkins, Inc.