Tuberculous scleritis

¹Department of Ophthalmology, Central Hospital of the Army, P.O Box 244, Kouba, 16063, University of Algiers I Benyoucef Benkhedda, 02 Street Didouche Mourad, Algiers, 16001, Algeria

^&Corresponding author
Islam Bechakh, Department of Ophthalmology, Central Hospital of the Army, P.O Box 244, Kouba, 16063, University of Algiers I Benyoucef Benkhedda, 02 Street Didouche Mourad, Algiers, 16001, Algeria

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Tuberculosis is a multifaceted disease, it is called the great imitator because it can take many appearances especially in the eye. Ocular manifestations in tuberculosis are rare since they are observed in only 1 to 2% of cases. It can accompany the general manifestations of the disease or be isolated. We report a case of a 64-year-old patient, who consulted the emergency room for the impaired general condition with fever. The onset of symptoms dates back to two months marked by the appearance of a pulmonary infection on day 7 after surgery for the anal abscess put on antibiotic therapy without improvement. Clinical examination found asthenia, anorexia, weight loss of 12kg in 2 months with fever at 41°C and headache. The pleuro-pulmonary examination and for tuberculin was positive. An ophthalmological opinion was requested following a painful red eye reported by the patient. The ophthalmological examination found on inspection a red scleral nodule of the prelimbic right eye richly vascularized in the lower temporal quadrant, more or less painful (A,B,C). Visual acuity is 10/10 in both eyes and slit-lamp examination shows slight conjunctival hyperemia, a richly vascularized scleral nodule per limbic inferior temporal, fixed on the deep planes. The rest of the ophthalmologic examination is unremarkable. When pulmonary tuberculosis was confirmed, anti-tuberculosis treatment was instituted. Evolution on day 15 is marked by a good evolution on the general plan and on the plan ophthalmologic with regression of inflammatory signs with almost disappearance of the scleral nodule and persistence of a small conjunctival uplift next to the lesion (D,E,F).

Figure 1: (A, B, C) scleral nodule, richly vascularized perilimbic in inferior temporal, fixed on the deep planes; (D, E, F) regression of inflammatory signs with virtual disappearance of the scleral nodule and persistence of a small conjunctival uplift next to the lesion