A CASE OF TUBERCULOSIS MENINGITIS WITH OCULAR PRESENTATION

Title A CASE OF TUBERCULOSIS MENINGITIS WITH OCULAR PRESENTATION
Author, Co-Author Chang Kim, Julie Kang-Kim
Topic
Year
2003
Day
Program Number
Poster 69
Room
Affiliation
VA Los Angeles Ambulatory Care Center
Abstract BACKGROUND: Large number of population in the world have either been infected by Mycobacterium tuberculosis or have been exposed to those carrying the disease with risk for developing clinical TB in later life. The disease process in its active state can involve various organs, and although rare, TB can also produce varied and widespread inflammatory damage to the eye while mimicking various other disease entities.

CASE REPORT(S): A 56 yo Caucasian male with hx of polysubstance abuse presented to VA LAACC Optometry Clinic with ocular sns and sxs consistent with presumed ocular toxoplasmosis, including acute onset of floaters, reduced BCVA, focal granulomatous retinal lesion, and severe panuveitis. Patient’s ocular condition progressively worsened which elicited empirical ocular toxoplasmosis therapy prior to T. gondii titer confirmation. Patient’s ocular presentation was subsequently followed by severe neurological deficit, including seizure, delusion and progressive hemiparesis requiring hospitalization. Based on initial head CT showing multiple, round periventricular lesions with vasogenic edema and clinically significant CSF study, possible differential dx of bacterial or TB meningitis, toxoplasmosis, metastasis and CNS lymphoma was considered. Patient subsequently underwent numerous imaging studies including CT, MRI and total body PET scan to evaluate for malignancy, laboratory studies, including bone marrow biopsy. In the absence of definitive radiological and histological findings for 1° malignancy or CNS lymphoma, a dx of TB was presumed and appropriate anti-TB therapy was instituted. Patient’s comparative MRI study showed progressive improvement of brain lesion along with his cognition and mobility; however, 3 months after initial onset of ocular symptoms, patient required a scleral buckle for retinal detachment originating in the same area of the previously noted tuberculous granuloma.

CONCLUSIONS: The dx of ocular tubercuosis often is clinical and is based on a hx suggestive of systemic TB, characteristic ocular lesions and laboratory evidence.
Affiliation of Co-Authors Private Practitioner
Outline