Frequently Relapsing Anterior Nodular Scleritis as the Initial Presentation of a Lethal Systemic Infection: Disseminated Tuberculosis with HIV Coinfection
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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.