An extremely rare case of endophthalmitis in an infant with congenital tuberculosis

ABSTRACT

Congenital tuberculosis (CTB) is the transmission of Mycobacterium tuberculosis infection from mother to infant during the intrauterine period or delivery. An 82-day-old infant presented to Nilratan Sircar Medical College and Hospital, Kolkata, with a history of persistent fever from Day 15 of age. Over the course of more than 2 months, there were pneumonia, hepatosplenomegaly and endophthalmitis which were unresponsive to a range of antibiotics, and there had been several admissions to local hospitals. On this admission, his chest radiograph and contrast-enhanced computed tomography (CECT) of the thorax demonstrated bilateral nodules and enlarged mediastinal lymph nodes. Ultrasound and CECT of the abdomen demonstrated hepatosplenomegaly with multiple hypodense enhancing lesions. GeneXpert of a gastric lavage on Day 2 of this admission detected M. tuberculosis without rifampicin resistance. The infant was diagnosed with tuberculosis (TB) complicated by caseating hepatic granulomas, which fulfilled Cantwell’s diagnostic criteria for CTB. Magnetic resonance imaging of the orbit demonstrated focal heterogeneous lesions involving the anterior portion of the left ocular bulb and vitreous, suggesting panophthalmitis, which was unresponsive to intravitreal antibiotics. Following commencement of standard anti-TB therapy from Day 90 of life, there was clinical and radiological recovery of endophthalmitis. The mother had a cachectic appearance owing to weight loss, and she had attended only one antenatal appointment. She had a positive acid-fast bacilli sputum stain but was unwilling to allow a genital tract smear. In the spectrum of CTB, TB panophthalmitis is an extremely rare presentation, and, as far as we are aware, it has not been reported in a child.

Abbreviations: AFB: acid-fast bacilli; ATT: anti-tuberculous therapy; CTB: congenital tuberculosis; CECT: contrast-enhanced computed tomography; CSF: cerebrospinal fluid; ESR: erythrocyte sedimentation rate; HIV: human immunodeficiency virus; TB: tuberculosis; MRI: magnetic resonance imaging; USG: ultrasonogram.

KEYWORDS:

• Congenital TB
• tuberculous endophthalmitis
• hepatic granulomas
• India

Acknowledgments

The authors are grateful for suggestions and guidance by Dr Anuvati Nag, Residential Medical Officer cum Clinical Tutor, Department of Gynaecology and Obstetrics, Nilratan Sircar Medical College and hospital.

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No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.

Notes on contributors

Kakali Roy

Kakali Roy is a Residential Medical officer-cum-clinical tutor, Department of Paediatrics, NRSMCH

Bageshree Saha

Bageshree Saha is a Academic junior residents, Department of Paediatrics, NRSMCH

Sandipan Sen

Sandipan Sen is a Senior resident, Department of Paediatrics, NRSMCH

Nivedita Manna

Nivediata Manna is a Academic junior residents, Department of Paediatrics, NRSMCH

Shreyanshi Biswas

Shreyanshi Biswas is a Senior Resident, Department of Ophthalmology, NRSMCH

Tania Roy

Tania Roy is a Academic junior residents, Department of Paediatrics, NRSMCH

Tilling Tani

Tilling Tani is a Senior resident, Department of Paediatrics, NRSMCH

Bakul Sarkar

Bakul Sarkar is a Academic junior residents, Department of Paediatrics, NRSMCH

Tapan Kumar SinhaMahapatra

Tapan Kumar SinhaMahapatra is a Professor and Head, Department of Paediatrics, NRSMCH