When the Eye Reveals Disseminated Tuberculosis: A Pediatric Case of Endophthalmitis With Severe CNS Involvement.

PURPOSE: This study aims to report a case of tuberculosis involving central nervous system (CNS) discovered thanks to tubercular endophathlmitis.

METHODS

This is a case report.

OBSERVATION: A 14-year-old male presented with acute visual loss, ocular pain, and redness of the right eye following a recent stay in India. The clinical history was notable for prolonged fever, night sweats, and headache. Ophthalmological examination revealed severe intraocular inflammation consistent with panuveitis and endophthalmitis. Neuroimaging demonstrated a large ring-enhancing lesion in the right hemisphere with significant mass effect. Initial microbiological investigations, including vitreous sampling, were negative. A positive interferon-gamma release assay and radiological findings raised suspicion for disseminated tuberculosis, and Mycobacterium tuberculosis DNA was subsequently detected in vitreous samples after repeating a second vitrectomy. Antitubercular therapy was started and definitive diagnosis was made with biopsy of the brain lesion, which demonstrated positive cultures for drug-sensitive M. tuberculosis. The clinical course was complicated by retinal detachment, paradoxical enlargement of the cerebral tuberculoma, and postoperative neurological deficits requiring surgical intervention and rehabilitation.

CONCLUSION

This case highlights the diagnostic complexity of ocular and CNS tuberculosis and emphasizes the need for a high index of suspicion, repeated targeted sampling, and multidisciplinary management to achieve timely diagnosis and appropriate treatment.