Ophthalmic Presentation of Disseminated Tuberculosis with Relapse-Immunological Profile

Abstract

TB as the cause of uveitis varies from 0.5 to 10.5%; low sensitivity of confirmatory laboratory investigations and inconsistency of diagnostic criteria leads to paucity of data. Diagnosis requires a high level of suspicion and is often presumptive based on indirect evidences. Interferon gamma, Interleukin-2 and Neopterin are key biomarkers in immuno-regulation of Mycobacterium tuberculosis infection. The relative shift from Interleukin-2 towards Interferon gamma (Interferon gamma/Interleukin-2) is more discriminatory for active tuberculosis. Protein carbonyl and Malondialdehyde, as oxidative stress markers, characterize active tuberculosis. A case of disseminated TB presenting with acute uveitis had a recurrent tubercular lymphadenitis after completing category I treatment under revised national tuberculosis control programme. The present study evaluates the potential utility of above mentioned biomarkers to predict atypical presentation in difficult cases of tuberculosis. Though tuberculous uveitis is amenable to treatment in early course of disease, the delay in diagnosis can have serious consequences for the patient.