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Bilateral Ocular Tuberculosis in a Child with Negative Tuberculin Skin Test (TST): A Diagnostic Dilemma

ABSTRACT Purpose To report a case of bilateral ocular tuberculosis (OTB) in a child with negative Tuberculin skin test (TST). Methods Case report. Observations A 12-year-old malnourished systemically asymptomatic boy presented with sudden profound loss of vision in both eyes. Dense vitritis precluded fundus visualization in right eye (RE). In left eye, fundus findings of extensive vasculitis associated with multifocal retinochoroiditis were suggestive of OTB. However, negative TST, normal chest X-ray, and gram negative bacteriuria led to confusion between endogenous endophthalmitis and OTB. Based on strong clinical suspicion and high-resolution chest tomography (HRCT) of thorax which was suggestive of TB-pneumonitis, a diagnosis of presumed OTB was made. A good response to anti-tubercular-treatment and corticosteroids, with resolution of retinochoroiditis lesions, vasculitis, and vitritis, further supported our diagnosis. Conclusions This case highlights the importance of keeping a high index of suspicion for TB-associated uveitis in children, based on clinical findings.