A 15-year-old West Indian boy had a left keratoconjunctivitis (KC) initially thought to be allergic in origin. He then developed a facial vesicular skin rash and a diagnosis of herpes simplex was suspected. Viral cultures were negative and there was a poor response to topical antiviral treatment. The KC progressed and became bilateral causing considerable reduction in the visual acuities. He complained of general fatigue and was pyrexial with generalised non-tender lymphadenopathy. There was a shadow in the upper lobe of the right lung. The bronchus was semioccluded by a non-caseating granuloma but no acid fast bacilli were found in the sputum or bronchial washings. In the presence of a strongly positive Heaf test, anti-tuberculous treatment was instituted which led to rapid resolution of all the systemic and ocular signs.
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