Título

BILATERAL INTERSTITIAL TUBERCULOUS KERATITIS IN A PATIENT WITH SCLEROUVEITIS AND TUBERCULOUS ENCEPHALOPATHY

Objetivo

To report a case of bilateral interstitial keratitis in a patient with recurrent episodes of sclerouveitis

Relato do Caso

A 10 year-old boy with recurrent episodes of red eye, pain and vision loss for the past 3 months in the OD and 9 months in OS. No systemic symptoms or past disease were reported. In the ophthalmological examination, OD had visual acuity of 20/25 with nodular scleritis, deep peripheral stromal corneal opacity with a deep neovascularization and anterior chamber reaction 1+/4+; OS had visual acuity of counting fingers with a deep stromal diffuse cornea opacity denser in the periphery with deep corneal neovascularization. Fundoscopy was normal in the OD and impossible in OS due to the corneal opacity. Ocular US was normal in the OS. Serological infectious disease tested negative for HIV, syphilis and toxoplasmosis; IGM negative and IGG positive for cytomegalovirus and herpes simplex and PPD test was positive (17 mm). During investigation the patient was hospitalized with encephalopathy presenting tonic-clonic seizures, confusion and trouble speaking. MRI revealed a bilateral meningeal nodular thickening with homogeneous enhancement in the cerebellar tentorium. CSF was normal. Tuberculous interstitial keratitis is a rare presentation and characteristically sectorial and unilateral due to late hypersensitivity reaction

Conclusão

This case is the first reported bilateral interstitial tuberculous keratitis related to nodular scleritouveitis and tuberculous encephalopathy. In endemic areas, ocular tuberculosis should be kept in mind in the differential diagnosis of patients with chronic and atypical corneal involvement.