Tuberculous sclerokeratouveitis in immunocompetent South African patients
Purpose
To describe the clinical characteristics of patients presenting with sclerokeratouveitis (SKU) secondary to Mycobacterium tuberculosis infection.
Methods
We describe 11 consecutive patients presenting with SKU to Tygerberg Hospital, Cape Town, South Africa. All patients underwent: 1) detailed ophthalmological evaluation, 2) tuberculin skin test (TST), 3) chest X-ray (CXR) to assess pulmonary involvement and 4) laboratory investigations to exclude other causes of ocular inflammation. Tuberculous SKU was diagnosed if: 1) clinical findings showed scleritis with adjacent peripheral keratitis and anterior uveitis, 2) TST was positive, 3) other causes of SKU were excluded and 4) prompt response to TB treatment (TBRx) without adjunctive anti-inflammatory agents was noted.
Results
The mean age was 29.1 ± 12.1 years. All 11 patients with SKU, bilateral in 3 cases, shared the following characteristics: 1) female sex, 2) immunocompetent (only 1 was HIV+ with CD4+ count = 615 cells/µL), 3) strongly positive TST (>15mm), 4) normal CXR, 5) decreased corneal sensation in same quadrants as scleral involvement and 6) marked improvement within 1 month and subsequent complete resolution on TBRx without any immunosuppressants.
Conclusion
In our highly endemic setting we have identified a distinctive presenting pattern of ocular TB. It is unclear why we have only documented this pattern in immunocompetent females and requires further research. Decreased corneal sensation may lead to incorrect diagnosis and treatment of herpetic disease with poor treatment outcomes if a high index of suspicion for ocular TB is not maintained.
Conflict of interest
No
Author 1
Last name
SMIT
Initials of first name(s)
DP
Department
Division of Ophthalmology, Stellenbosch University
City
Cape Town
Country
South Africa
Author 2
Last name
Mathew
Initials of first name(s)
D
City
Cape Town
Country
South Africa
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