Seeing the Spots: A Rare Case of Ocular Tuberculosis & Innovative Treatment
(Hook: Starts with a relatable symptom, then introduces the unusual case. Focuses on the visual impact for reader engagement.)
Have you ever experienced blurry vision that just wouldn’t clear up? For a 21-year-old woman, this wasn’t a simple case of needing glasses. It was the first sign of a rare and potentially serious condition: ocular tuberculosis (TB). While tuberculosis is often associated with lung infections, it can spread to other parts of the body, including the eyes, causing significant vision loss. This case highlights a fascinating instance of disseminated TB presenting with unusual ocular manifestations and the innovative treatment approach used to restore her sight.
(Keyword: Ocular Tuberculosis – strategically placed early for SEO)
The Silent Spread: Understanding Ocular Tuberculosis
Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, typically affects the lungs. However, in some cases, the infection can disseminate throughout the body, reaching organs like the eyes. Ocular tuberculosis is relatively uncommon, accounting for a small percentage of all TB cases, but it can lead to severe visual impairment if left untreated. The infection often manifests as inflammation within the eye, known as uveitis, and can present in various forms.
This particular case, recently documented, presented with a complex picture. The patient initially experienced shortness of breath and headaches, followed by progressively worsening vision in both eyes. A positive Mantoux test and TB Gold test confirmed a systemic TB infection, and a chest HRCT scan revealed the telltale signs of miliary tuberculosis – tiny, widespread nodules in the lungs. Importantly, tests for HIV and Hepatitis B were negative, ruling out common co-infections.
(Detailed Breakdown of the Case – mirroring the source material, but in a narrative, accessible style)
Upon examination, doctors found significant vision loss in both eyes. The right eye (RE) had a visual acuity of 6/12, while the left eye (LE) was severely affected, registering at 1/60. A closer look inside the eyes revealed the key diagnostic clue: choroidal granulomas. These are clusters of inflammatory cells forming bumps under the retina, appearing as yellowish lesions with central clearing. The LE showed a particularly large granuloma directly impacting the macula – the central part of the retina responsible for sharp, detailed vision.
Further investigation using Optical Coherence Tomography (OCT) – a sophisticated imaging technique – confirmed the presence of these choroidal bumps and revealed fluid buildup under the retina. The patient also exhibited splenomegaly (enlarged spleen) on abdominal ultrasound, further supporting the diagnosis of disseminated TB.
(Focus on Treatment & Innovation – highlights the unique approach)
Recognizing the severity of the macular involvement in the LE, the medical team opted for a combined treatment strategy. The patient was already started on standard anti-tuberculosis therapy (ATT) and oral steroids, but given the size and location of the granuloma in the LE, they decided to add intravitreal injections – injections directly into the eye – of both bevacizumab (an anti-VEGF drug) and moxifloxacin (an antibiotic). This approach, while considered “off-label” (meaning not specifically approved for this use), aimed to quickly reduce inflammation and combat the infection directly within the eye.
The RE, with smaller, more discrete granulomas, was managed with continued ATT and steroids alone.
(Results & Takeaway – emphasizes positive outcomes and future implications)
The results were encouraging. Within just three weeks, the patient’s vision in the RE improved to 6/9, and her vision in the LE showed signs of improvement, reaching 2/60. Follow-up fundus photographs and OCT scans showed a clear regression of the granulomas in both eyes, demonstrating the effectiveness of the combined treatment approach. By the second month, the granulomas had completely resolved.
This case underscores the importance of considering ocular tuberculosis in patients presenting with unexplained uveitis, especially those with a history of TB exposure or systemic symptoms. The innovative use of intravitreal anti-VEGF and antibiotic injections, alongside standard ATT and steroids, offers a promising treatment option for patients with severe ocular TB, potentially preventing irreversible vision loss. Further research is needed to fully evaluate the efficacy and safety of this combined approach, but this case provides a valuable insight into managing this rare and challenging condition.
Target Audience: General public interested in health, medical students, ophthalmologists, and individuals seeking information about tuberculosis and eye health.
SEO Considerations:
- Keywords: Ocular Tuberculosis, Miliary Tuberculosis, Choroidal Granuloma, Anti-VEGF, Uveitis, TB, Vision Loss, OCT Scan, Intravitreal Injection
- Internal Linking: Link to other relevant articles on Archyde.com about tuberculosis, uveitis, and eye health.
- Image Alt Text: Descriptive alt text for all images, including relevant keywords.
- Meta Description: A concise and compelling summary of the article, including the primary keyword.
- Headings & Subheadings: Clear and logical headings to improve readability and SEO.
