Brief clinical summaries of TB-uveitis patients
| Patient | Demographic | PMH | Initial eye exam | Treatment and response | Other findings and history |
|---|---|---|---|---|---|
| A | 54 year F, from Mexico | IDDM, HTN, dyslipidaemia, renal insufficiency | Markedly asymmetric uveitis, OD >OS. Large KPs | RIPE, topical prednisolone acetate 1%, PO prednisone; complete resolution uveitis by 3-month visit, with no further recurrence after more than 9 months of follow-up, off topical and systemic steroids | Outside physician initially diagnosed patient with VKH. Despite history of untreated positive PPD, patient started mycophenolate mofetil, cyclosporine and prednisone, as well as topical prednisolone acetate, without clinical improvement and without development of a sunset glow fundus. Positive IGRA. Normal CXR |
| B | 54 year M, from Mexico | IDDM, HTN, dyslipidaemia, CAD | OU: 2+ AC cell, 2+ anterior vitritis | RIPE, topical prednisolone acetate 1%; complete resolution of uveitis by 3.5-month visit, with no further recurrence after more than 8 months and is no longer taking topical steroids | Brother and nephew in Mexico diagnosed with pulmonary TB. Negative PPD. Positive IGRA. Normal CXR |
| C | 48 year F, from Mexico | None | OU: stellate KPs, 1+ AC cell, retinal vasculitis and many grey chorioretinal scars; multifocal choroiditis | RIPE, topical prednisolone acetate 1%; complete resolution of uveitis by 3-month visit, with no further recurrence after more than 8 months and is no longer taking topical steroids | No close contact with TB-infected individuals. Positive PPD. Positive IGRA. Normal CXR |
| D | 57 year M, from Mexico | None | OU: 3+ AC cell | RIPE, topical prednisolone acetate 1%; complete resolution of uveitis by 2-month visit, with no further recurrence after more than 7 months and is no longer taking topical steroids | History of recurrent uveitis over several years. Vague recollection that his neighbour in Mexico had been diagnosed with TB. Had been treated with topical steroids and PO prednisone > 1 year. Positive PPD. Negative IGRA. Normal CXR |
| E | 34 year M, from Mexico | Chronic osteomyelitis | OS: granulomatous anterior uveitis and a non-tender, inflamed scleral nodule in the left eye | RIPE, PO prednisone (40 mg/day); the anterior chamber inflammation resolved after 4 months; however, the patient remained on prednisone for the duration of the scleral inflammation, which resolved over the course of the subsequent 4 months | During the course of treatment, patient was admitted for workup of pathological knee fracture, which showed TB osteomyelitis of the left femur. Positive PPD. Right upper lobe disease on CXR. PCR of scleral nodule positive for TB |
| F | 51 year M, from China | None | OD: 2+ AC cell, 3+ anterior vitritis, vitritis overlying a slightly elevated, superonasal choroidal lesion; OS: 1+ AC cell | RIPE, PO prednisone (40 mg/day); intraocular inflammation subsided after 2 months of therapy without further recurrences 6 months after steroids have been tapered off. The skin lesions also resolved with minor scar formation | Referred by outside ophthalmologist for concern of acute retinal necrosis. Physical examination showed numerous lesions on the lower extremities, with biopsy specimens showing a reactive process and negative acid-fast stains. Positive PPD. CXR: fullness in right para-tracheal region |
AC, anterior chamber; CAD, coronary artery disease; CXR, chest x-ray; HTN, hypertension; IDDM, insulin-dependent diabetes mellitus; IGRA, interferon γ release assay; KP, keratic precipitate; PMH, past medical history; PPD, purified protein derivative assay; RIPE, rifampicin, isoniazid, pyrazinamide and ethambutol; OD, right eye; OS, left eye; OU, both eyes; PO, by mouth; TB, tuberculosis; VKH, Vogt -Koyanagi -Harada disease.