Frequently Relapsing Anterior Nodular Scleritis as the Initial Presentation of a Lethal Systemic Infection: Disseminated Tuberculosis with HIV Coinfection

Abstract

Background.Scleritisisapainfulinflammatoryoculardiseaseoftenassociatedwithanunderlyingsystemicillnessmostlyhaving an autoimmune aetiology.Tuberculosis usuallypresentsas pulmonaryinfection, andthe ocularpresentationis consideredtobe rare.Casepresentation.Wepresentamalewhodevelopedprolongedpyrexiafollowingsystemicsteroidswhilebeinginvestigated forafrequentlyrelapsinganteriorscleritis.Biopsyofsclerademonstratedacid-fastbacilli,andhistologyofscleraandlymphnode showedgranulomatousinflammationwithcaseation.ContrastCTdemonstratedmediastinalandviscerallymphadenopathywith pulmonarychangessuggestingdisseminatedtuberculosis.Later,WesternblotconfirmedcoinfectionwithHIVwithaCD4count of71cells/mm3.Hewastreatedwithantituberculousmedications,andthenHAARTwasinitiatedwithintwomonths.Heshowed good response and showed a partial resolution of scleritis at the end of two months. Conclusion. Tuberculosis tends to occur in unusualsiteswhencoinfectedwithHIV.Scleritisisarareextrapulmonarymanifestationoftuberculosis.Highdegreeofsuspicion is critical in making diagnosis and commencing early treatment.