Singhal Deepali, Maharana Prafulla Kumar, Sharma Namrata, Titiyal Jeewan S
Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India.
Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2018 Apr 5;2018:bcr-2017-222571. doi: 10.1136/bcr-2017-222571.
An 11-year-old female patient presented with diminution of vision in both the eyes for the last 4 days. She had redness, watering and photophobia for the past 11 days. Slit lamp examination revealed multiple disc-shaped corneal stromal infiltrates with an overlying epithelial defect and hypopyon in both the eyes. A provisional diagnosis of infective keratitis was made. The patient was started on empirical antimicrobial therapy. However, no improvement was noted over the next 72 hours. Microbiological examination of the corneal scraping from both the eyes was negative. Considering the above, provisional diagnosis was changed to immune stromal keratouveitis and the patient was started on topical steroids. Further evaluation revealed a positive Mantoux test (30×20 mm) and contrast enhanced CT chest showing pulmonary nodules, suggestive of tuberculosis. The patient was subsequently started on antitubercular treatment. The infiltrates along with the ulcer and anterior uveitis responded dramatically to the revised treatment and resolved completely within 7 days of therapy.
一名11岁女性患者在过去4天出现双眼视力下降。在过去11天里，她有眼红、流泪和畏光症状。裂隙灯检查发现双眼有多个盘状角膜基质浸润，伴有上皮缺损和前房积脓。初步诊断为感染性角膜炎。患者开始接受经验性抗菌治疗。然而，在接下来的72小时内未观察到改善。双眼角膜刮片的微生物学检查为阴性。考虑到上述情况，初步诊断改为免疫性基质性角膜葡萄膜炎，患者开始使用局部类固醇治疗。进一步评估显示结核菌素试验阳性（30×20毫米），胸部增强CT显示肺部结节，提示肺结核。患者随后开始接受抗结核治疗。浸润灶、溃疡和前葡萄膜炎对修订后的治疗反应显著，在治疗7天内完全消退。
