Rafiezadeh Parviz, Schmack Ingo, Shajari Mehdi, Kohnen Thomas
Department of Ophthalmology, Goethe-University, Frankfurt, Germany.
J Curr Ophthalmol. 2018 May 18;30(4):381-383. doi: 10.1016/j.joco.2018.03.001. eCollection 2018 Dec.
To report a case of autoimmune keratitis in a patient with mycobacterium tuberculosis (MBT).
An 84-year-old male with pulmonary tuberculosis (TB) was admitted with chronic, non-healing bilateral ulcerations of the inferior peripheral cornea associated with stromal and subconjunctival nodules.
Clinical examination revealed circumscribed peripheral corneal ulceration with whitish nodules in adjacent stromal and subconjunctival tissue. Microbiological cultures of the corneal tissue were negative for MBT and other microbial pathogens; however, enzyme-linked immunosorbent assay (ELISA) of blood and corneal samples showed significantly elevated levels of IgM and IgA against MBT. In addition to systemic anti-tuberculosis therapy, the patient was treated topically with Polyspectran eye drops, Dexamethasone eye drops, and Bepanthen ointment, for 2 weeks. Both eyes showed dramatic improvement after 2 weeks.
The present report demonstrates that MBT is able to initiate delayed autoimmune response within the corneal tissue during an intensive phase of anti-tuberculosis treatment.
报告一例患有结核分枝杆菌（MBT）的患者发生自身免疫性角膜炎的病例。
一名84岁患有肺结核（TB）的男性因双侧下角膜慢性、不愈合溃疡并伴有基质和结膜下结节入院。
临床检查发现角膜周边局限性溃疡，相邻基质和结膜下组织有白色结节。角膜组织的微生物培养未检测到MBT及其他微生物病原体；然而，血液和角膜样本的酶联免疫吸附测定（ELISA）显示抗MBT的IgM和IgA水平显著升高。除全身抗结核治疗外，患者局部使用多光谱眼药水、地塞米松眼药水和拜多邦软膏治疗2周。2周后双眼均有显著改善。
本报告表明，在抗结核治疗的强化阶段，MBT能够在角膜组织内引发迟发性自身免疫反应。
