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Case Report
Activation of tubercular scleritis after local immune suppression
1 Transitional Year PGY1, Metrowest Medical Center, Framingham, MA 01702, Tufts New England Eye Center, Tufts University School of Medicine, Boston, MA, USA
2 Assistant Professor, Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
Address correspondence to:
Erina Lanzo
33 Pond Ave, #1223, Brookline, MA 02445,
USA
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Article ID: 100016Z17EL2020
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Lanzo E, Swamy R. Activation of tubercular scleritis after local immune suppression. J Case Rep Images Opthalmol 2020;3:100016Z17EL2020.ABSTRACT
Introduction: This article describes the challenge to diagnose and manage a case of treatment-refractory scleritis in the postoperative setting after routine trabeculectomy for uncontrolled glaucoma.
Case Report: This case features a 63-year old veteran who presented after trabeculectomy with perioperative use of mitomycin C (MMC) with unresolving scleritis refractory to topical and oral steroid treatment. Infectious and inflammatory work-up was negative except for detection of tuberculosis (TB) on Quantiferon Gold test. The patient was sent to infectious disease clinic, where it was elucidated that he was high risk for Mycobacterium tuberculosis reactivation and had been previously treated with single agent isoniazid. He was started on multidrug anti-TB therapy and his scleritis resolved quickly thereafter. Concurrent management of his glaucoma required special considerations and we elected for a minimally invasive approach, given the complications anticipated by operating on an eye with active infection.
Conclusion: We hypothesize that this is the first documented case of localized immunosuppression caused by the use of MMC and/or local steroid use, leading to reactivation of latent TB. Management of the infection and of the concurrent uncontrolled pressures in the eye posed a unique challenge.
Keywords: Glaucoma, Mitomycin C, Scleritis, Tubercular scleritis
SUPPORTING INFORMATION
Author Contributions
Erina Lanzo - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ramya Swamy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Erin Lanzo et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
