MULTIFOCAL TUBERCULOSIS COMPLICATED BY BILATERAL BOUCHUT'S TUBERCULOMA: A CASE REPORT.

Published 2022 - 26th ESCRS Winter Meeting

Reference: P228 | Type: Abstracts | DOI: 10.82333/7wzp-vp35

Authors: Mohcine El Mhadi* ¹ , Mohammed El mellaoui ¹ , Ahmed Alami ¹ , Jaouad Laayoun ¹ , Adil Bouzidi ¹ , Aziz El ouafi ¹ , Said Iferkhass ¹

¹Ophthalmology department,Military hospital Moulay Ismail of Meknes,Meknes,Morocco

Purpose

Tuberculosis is a transmissible infectious disease caused by Mycobacterium tuberculosis.

Extra-pulmonary tuberculosis accounts for 20% to 40% of all clinical forms, of which 1 to 2% are ocular involvement.

The ophthalmological disorders linked to tuberculosis are diverse, including Bouchut's tuberculoma.

The purpose of our observation is to emphasize the value of ophthalmologic examination, retinography as well as angiography in guiding the diagnosis of tuberculosis.

Setting

We report the case of a 29-year-old patient, hospitalized in the pneumology department for treatment of multifocal tuberculosis.

A gradual decrease in his visual acuity is reported 1 week after his hospitalization, prompting an ophthalmological consultation.

Methods

The corrected visual acuity was 9/10th in both eyes, and the intraocular pressure was 14 mmHg in the right and 15 mmHg in the left eye.

Fundus examination revealed in the right eye a yellowish protruding, para-macular formation (inferior temporal) with blurred outlines, measuring 1 papillary diameter (evoking a choroidal tuberculoma) with chorio-retinal folds, small flaming hemorrhage, and papillary edema. In the left eye, we found a serous retinal detachment with chorio-retinal folds, and papillary edema.

The patient had a fluorescein retinal angiography: the areas corresponding to the location of the tuberculoma shown an early Hypofluorescence, then a progressing hyperfluorescence from the periphery to the center of the lesions (roundel image). In late stages, the lesions show diffuse hyperfluorescence.

Mantoux and QuantiFERON TB Gold Tests are both positive.

Multifocal tuberculosis was retained on the association of pulmonary tuberculosis and Tuberculous spondylodiscitis.

Results

Tuberculosis remains a major cause of worldwide death and morbidity. In Morocco there are around 25 thousand new cases per year.

The ophthalmological disorders linked to tuberculosis are diverse: all structures of the eye can be concerned (without a pathognomonic presentation).

There are clinical forms strongly suggestive of ocular tuberculosis such as Bouchut’s tuberculoma.

On the etiopathogenic side, Bouchut's tuberculoma is linked to the hematogenous dissemination of Mycobacterium Tuberculosis as for all other organs.

Confirmation of ocular tuberculosis is based on evidence of Mycobacterium Tuberculosis in ocular tissues or fluids. However, the diagnosis is most often presumptive, based on a set of arguments (tuberculosis counting; clinical; radiological; Mantoux test; Quantiferon®; anti-tuberculosis treatment test).

Conclusion

Bouchut's tuberculoma can be a valuable aid in the diagnosis of systemic tuberculosis by a simple fundus examination.

Considering the possibility of asymptomatic clinical forms, the clinician should remember to request an eye fundus in any patient with pulmonary or extra-pulmonary tuberculosis, in order to detect ocular tuberculosis in time and avoid sequelae.