Matsubayashi Minako, Matsushima Hidekazu, Kawabe Rie
Department of Respiratory Medicine, Saitama Red Cross Hospital, 8-3-33, Kamiochiai, Chuo-ku, Saitama-shi, Saitama 338-8553, Japan.
Kekkaku. 2012 Jun;87(6):469-74.
Uveitis has many etiologies, but tuberculous uveitis is rare. We herein report 2 cases of uveitis due to tuberculosis infection. The first case was a 28-year-old man who was showed abnormal shadows in the chest radiographic examination performed in search of the etiology of uveitis. Computed tomography (CT) of the chest revealed hilar and mediastinal lymphadenopathy, small nodules, and consolidation, with a small cavity in the right upper lobe. An ulcerated nodule in the truncus intermedius and stenosis of the right middle lobe bronchus were found on bronchoscopy. The biopsy of the nodule in the truncus intermedius showed a small granuloma containing giant cells, consistent with mycobacterial infection. The culture of bronchial washings from the right upper lobe grew Mycobacterium tuberculosis. Diagnosis of pulmonary tuberculosis, tuberculous lymphadenitis, bronchial tuberculosis, and tuberculous uveitis was made. The patient was treated with antituberculosis drugs and his disease, including uveitis, improved. The second case was a 36-year-old man who presented with right hemiparesis, dysarthria, and visual loss of the left eye. He was diagnosed with neuro-Sweet disease causing optic neuritis and visual loss. His chest CT showed a nodule with centrilobular opacities in the left lower lobe that suggested mycobacterial infection. PCR of the bronchial washing from the left lower lobe was positive for M.tuberculosis and the diagnosis of pulmonary tuberculosis was established. Treatment with antituberculosis drugs and corticosteroids was initiated and his pulmonary lesion improved. However, bilateral tuberculous uveitis developed 15 days after initiation of the treatment. The uveitis gradually deteriorated thereafter despite continuation of antituberculosis therapy. Photocoagulation finally halted the disease progression. In both patients with uveitis presented here, chest radiographs and CT scans were important in determining the etiology of the uveitis. It is difficult to find the etiology of uveitis, and general examinations including the lungs are helpful to pinpoint tuberculosis as the etiology of uveitis. As tuberculous uveitis is sometimes asymptomatic and resistant to treatment, ophthalmological examination is recommended for patients with pulmonary tuberculosis.
葡萄膜炎有多种病因，但结核性葡萄膜炎较为罕见。我们在此报告2例因结核感染引起的葡萄膜炎病例。第一例是一名28岁男性，在为寻找葡萄膜炎病因进行的胸部X线检查中显示有异常阴影。胸部计算机断层扫描（CT）显示肺门和纵隔淋巴结肿大、小结节及实变，右上叶有一个小空洞。支气管镜检查发现中间段有一个溃疡结节及右中叶支气管狭窄。中间段结节活检显示有一个含巨细胞的小肉芽肿，符合分枝杆菌感染。右上叶支气管灌洗培养出结核分枝杆菌。诊断为肺结核、结核性淋巴结炎、支气管结核及结核性葡萄膜炎。患者接受抗结核药物治疗，其病情包括葡萄膜炎得到改善。第二例是一名36岁男性，表现为右侧偏瘫、构音障碍及左眼视力丧失。他被诊断为导致视神经炎和视力丧失的神经Sweet病。他的胸部CT显示左下叶有一个伴有小叶中心型混浊的结节，提示分枝杆菌感染。左下叶支气管灌洗的聚合酶链反应（PCR）检测结核分枝杆菌呈阳性，确诊为肺结核。开始用抗结核药物和皮质类固醇治疗，其肺部病变有所改善。然而，治疗开始15天后出现双侧结核性葡萄膜炎。此后尽管继续抗结核治疗，葡萄膜炎仍逐渐恶化。最终光凝治疗阻止了病情进展。在此呈现的这2例葡萄膜炎患者中，胸部X线片和CT扫描对于确定葡萄膜炎的病因很重要。葡萄膜炎的病因很难找到，包括肺部检查在内的全面检查有助于明确结核是葡萄膜炎的病因。由于结核性葡萄膜炎有时无症状且对治疗有抵抗性，建议对肺结核患者进行眼科检查。
