Frequently Relapsing Anterior Nodular Scleritis as the Initial Presentation of a Lethal Systemic Infection: Disseminated Tuberculosis with HIV Coinfection
JavaScript is disabled for your browser. Some features of this site may not work without it.
Frequently Relapsing Anterior Nodular Scleritis as the Initial Presentation of a Lethal Systemic Infection: Disseminated Tuberculosis with HIV Coinfection
Kariyawasam, A. G. T. A.; Fernando, C. L.; De Silva, P. U. T.; Sanjeewa, A. D. S. S.; Wijewickrama, D. N.; Herath, H. M. M.; Weerarathna, T. P.
Citation:Kariyawasam AGTA, Fonseka CL, De Silva PUT, Sanjeewa ADSS, Wijewickrama DN, Herath HMM, Weerarathna TP. Frequently Relapsing Anterior Nodular Scleritis as the Initial Presentation of a Lethal Systemic Infection: Disseminated Tuberculosis with HIV Coinfection. Case Rep Infect Dis. 2020 Jan 31;2020:9020864. doi: 10.1155/2020/9020864. PMID: 32082660; PMCID: PMC7013353.
Date:2020-01-31
Abstract:
Background.Scleritisisapainfulinflammatoryoculardiseaseoftenassociatedwithanunderlyingsystemicillnessmostlyhaving an autoimmune aetiology.Tuberculosis usuallypresentsas pulmonaryinfection, andthe ocularpresentationis consideredtobe rare.Casepresentation.Wepresentamalewhodevelopedprolongedpyrexiafollowingsystemicsteroidswhilebeinginvestigated forafrequentlyrelapsinganteriorscleritis.Biopsyofsclerademonstratedacid-fastbacilli,andhistologyofscleraandlymphnode showedgranulomatousinflammationwithcaseation.ContrastCTdemonstratedmediastinalandviscerallymphadenopathywith pulmonarychangessuggestingdisseminatedtuberculosis.Later,WesternblotconfirmedcoinfectionwithHIVwithaCD4count of71cells/mm3.Hewastreatedwithantituberculousmedications,andthenHAARTwasinitiatedwithintwomonths.Heshowed good response and showed a partial resolution of scleritis at the end of two months. Conclusion. Tuberculosis tends to occur in unusualsiteswhencoinfectedwithHIV.Scleritisisarareextrapulmonarymanifestationoftuberculosis.Highdegreeofsuspicion is critical in making diagnosis and commencing early treatment.
