Case Report: Ocular Tissue Diagnosis of Previously Undiagnosed, Extensively Drug-Resistant Pulmonary Tuberculosis

Abstract

We describe a patient with concurrent ocular and pulmonary tuberculosis (TB) in whom the diagnosis of extensively drug-resistant TB was made through phenotypic drug-sensitivity testing of an ocular fluid sample after sputum testing yielded incomplete results. Our results are remarkable, because culture-based diagnosis of TB in ocular fluid is unusual. We not only overcame this limitation, but also were able to create a complete drug-sensitivity testing profile from ocular samples, which led to effecting appropriate therapy for the patient.

Figure 1.

Clinical and microbiological features at presentation. (A) Slit-lamp biomicroscopy of inferior cornea and sclera showing limbal perforation with iris prolapse (arrow) and multiple perilimbal scleral nodules (arrowheads). (B) Sectional optical coherence tomography along the white line in (A) reveals prominent edema of the conjunctival stroma–episclera complex (arrow) and low reflective intrascleral edema (star). (C) Ziehl–Neelsen staining of anterior chamber aspirate showing thin, beaded acid-fast bacilli (arrowheads) and pigment granules (×100 magnification, bright-field microscopy). (D) Confluent, nonpigmented, rough, dry colonies (arrowheads) of Mycobacterium tuberculosis in Lowenstein–Jensen medium.