Abstract
Descriptive caption
A 44-year-old Caucasian woman with Behçet's disease and ulcerative colitis on adalimumab presented with right eye presumed inflammatory panuveitis (A). She showed a limited response to oral prednisolone. Vitreous biopsy revealed Mycobacterium tuberculosis (TB). Systemic imaging, including chest radiography (diffuse patchy opacities; B) and MRI head, confirmed disseminated TB. Following discussion at the TB multi-disciplinary team meeting, she was switched to systemic dexamethasone as per the Thwaites protocol, adapted for the management of TB with cerebral involvement in immunocompromised individuals. Two weeks after commencing anti-TB therapy and while on tapering dexamethasone, she developed severe intraocular inflammation (organised hypopyon filling the entire anterior chamber, with overlying superficial vessels; C), which improved after dexamethasone escalation (D). She was systemically well throughout and had a negative QuantiFERON 12 months earlier. This case highlights the consideration of TB in immunosuppressed patients despite a previous negative QuantiFERON and the importance of cautious and gradual tapering of systemic corticosteroids in the first 3 months after commencement of treatment.
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Informed consent was obtained from the patient
Footnotes
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.