Panuveitis: a case of suspected ocular tuberculosis
The present case has bee reported in the journal Southwest Respiratory and Critical Care Chronicles.

Case highlights:-
• There remains significant controversy about many aspects of ocular tuberculosis. A recent article by Ang does an excellent job of summarizing three significant controversies that exist in ocular tuberculosis.

• First, terminology used in ocular tuberculosis requires standardization and consensus among clinicians to understand the disease burden.

• Second, the diagnosis of ocular TB needs to distinguish between a TB infection of the eye and inflammation associated with a remote or systemic TB infection.

• Finally, guidelines need to be established for the treatment regimen and duration of therapy for ocular tuberculosis.Despite advances in diagnostic and therapeutic techniques, ocular inflammation associated with tuberculosis remains a challenging disorder.

A 32-year-old man presented to the emergency room with a six-week history of blurry vision and ocular pain, which had rapidly worsened over the preceding 10 days. He noted that his initial symptoms began in the left eye (OS) and later involved the right eye (OD). Review of systems revealed photophobia, floaters in both eyes (OU), fatigue, anorexia, weight loss, chills, and night sweats.

Physical examination revealed hand motion vision and unreactive pupils OU. Examination of the anterior segment revealed mild conjunctival injection, trace endothelial pigment deposition, significant anterior chamber cells, and flare without hypopyon.

The iris demonstrated 360 degrees of posterior synechia with fibrous lens deposits. There was no view of the posterior segment OD; OS presented a challenging view with 2+ cell and an inferior retinal detachment (RD) about 4-5 clock hours in size. B-scan demonstrated diffuse exudative RDs, choroidal thickening, and vitritis OU.

The patient was hospitalized to initiate management of panuveitis with systemic corticosteroids (IV methylprednisolone), topical atropine drops (gtts), and topical prednisolone acetate gtts. He underwent an extensive evaluation, including CBC, ESR/CRP, Treponema pallidum hemagglutination test, rheumatoid factor, antinuclear antibody, cyclic citrulline peptide, HIV, HLA-B27, toxoplasmosis antibody, Quantiferon Gold, angiotensin converting enzyme level, Lyme antibody, and chest x-ray.



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