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Agarwal M, Patnaik G, Agarwal S, Iyer G, Anand AR, Ar G, Biswas J, Zierhut M. Tuberculous Scleritis and Multidrug Resistance. Ocul Immunol Inflamm 2021; 30:915-924. [PMID: 33416427 DOI: 10.1080/09273948.2020.1853176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To present a case of necrotizing sclerokeratitis in a patient with multidrug-resistant tuberculosis and study the challenges in diagnosis and management of anterior tuberculous scleritis.Methods: Retrospective observational case report and review of anterior tuberculous scleritis.Results: A 28-year-old woman, previously diagnosed as presumed tubercular panuveitis, presented with necrotizing sclerokeratitis and progressed to develop panophthalmitis. Laboratory investigations revealed multidrug-resistant Mycobacterium tuberculosis as the etiological agent. We reviewed cases of anterior tuberculous scleritis published in the literature, with regards to clinical features, microbiological investigations, treatment, and outcomes. Treatment includes standard antitubercular therapy, with or without systemic corticosteroids. Poor response to treatment is seen either due to delayed diagnosis or drug resistance, and the significance of the same is highlighted in our case.Conclusion: Diagnosis of tuberculous scleritis is a challenge. Therapeutic failure must alert the clinician for drug resistance which is diagnosed early, can prevent the devastating outcomes.
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Affiliation(s)
- Mamta Agarwal
- Uveitis & Cornea Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Gazal Patnaik
- Uveitis Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Shweta Agarwal
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Geetha Iyer
- CJ Shah Cornea Services, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - A R Anand
- L & T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Gayathri Ar
- Pulmonologist, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Uveitis & Ocular Pathology Department, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Manfred Zierhut
- Department of Ophthalmology, University of Tubingen, Tubingen, Germany
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